Provider Demographics
NPI:1720566623
Name:GEORGE, LORI A
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREAT OAKS BLVD STE 127
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-7903
Mailing Address - Country:US
Mailing Address - Phone:518-250-5330
Mailing Address - Fax:518-608-0020
Practice Address - Street 1:100 GREAT OAKS BLVD STE 127
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-7903
Practice Address - Country:US
Practice Address - Phone:518-250-5330
Practice Address - Fax:518-608-0020
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680136382101YM0800X
NY010139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health