Provider Demographics
NPI:1720476591
Name:LOREE-PRYOR, HILDA KAY (LCSW-R, CASAC)
Entity type:Individual
Prefix:
First Name:HILDA
Middle Name:KAY
Last Name:LOREE-PRYOR
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:H
Other - Middle Name:KAY
Other - Last Name:LOREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R, CASAC
Mailing Address - Street 1:42 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:585-919-0014
Mailing Address - Fax:
Practice Address - Street 1:42 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-919-0014
Practice Address - Fax:585-393-0014
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085014-R1041C0700X
NY26426101YA0400X
NY071955-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04889483Medicaid