Provider Demographics
NPI:1174784193
Name:LAND, LORRAINE (PC)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3803
Mailing Address - Country:US
Mailing Address - Phone:215-849-3104
Mailing Address - Fax:215-843-2618
Practice Address - Street 1:5545 B ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6357
Practice Address - Country:US
Practice Address - Phone:610-731-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004340101YP2500X
DCPRC14110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional