Provider Demographics
NPI:1699072801
Name:LORICK, CHANDRAWATTIE (MA, TSLD)
Entity type:Individual
Prefix:MRS
First Name:CHANDRAWATTIE
Middle Name:
Last Name:LORICK
Suffix:
Gender:F
Credentials:MA, TSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-11 130TH STREET
Mailing Address - Street 2:SOUTH RICHMOND HILL
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11419
Mailing Address - Country:US
Mailing Address - Phone:718-805-8002
Mailing Address - Fax:
Practice Address - Street 1:95-11 130TH STREET
Practice Address - Street 2:SOUTH RICHMOND HILL
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:718-805-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist