Provider Demographics
NPI:1699599605
Name:LONBRAJ INC.
Entity type:Organization
Organization Name:LONBRAJ INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FARRAH
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:786-457-1709
Mailing Address - Street 1:8 PLEASANT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3773
Mailing Address - Country:US
Mailing Address - Phone:786-457-1709
Mailing Address - Fax:
Practice Address - Street 1:490 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3741
Practice Address - Country:US
Practice Address - Phone:404-827-8256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty