Provider Demographics
NPI:1427104165
Name:THORNTON, LORI L (LCSW,PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:L
Last Name:THORNTON
Suffix:
Gender:F
Credentials:LCSW,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 COUNTY ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:12865-3205
Mailing Address - Country:US
Mailing Address - Phone:518-567-9328
Mailing Address - Fax:
Practice Address - Street 1:512 COUNTY ROUTE 30
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NY
Practice Address - Zip Code:12865-3205
Practice Address - Country:US
Practice Address - Phone:518-567-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032486-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY362392OtherMVP HEALTHCARE
NY589702000OtherBLUE CROSS BLUE SHIELD
NY362392OtherMVP HEALTHCARE
NY589702000OtherBLUE CROSS BLUE SHIELD