# GREAT LAKES NP OF PSYCHIATRY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790273308
- **Authorized official:** MS. LORRAINE A. LOPEZ PMHNP (OWNER)
- **Authorized official phone:** (716) 908-1711

## Contact information

- **Practice address:** 3802 SENECA ST, WEST SENECA, NY 14224-3433
- **Practice address phone:** (716) 677-5418
- **Mailing address:** PO BOX 61, EAST AMHERST, NY 14051-0061
- **Mailing address phone:** (716) 908-1711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | F400896 | NY | Yes |

## Other

- **Enumeration date:** 04/30/2018
- **Last updated:** 04/30/2018