1861967200 NPI number — MRS. LORI B HARRISON MSW, LCSW

Table of content: MRS. LORI B HARRISON MSW, LCSW (NPI 1861967200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861967200 NPI number — MRS. LORI B HARRISON MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
LORI
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCURDY
Provider Other First Name:
LORI
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861967200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 WESTGLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN CARBON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62034-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-276-1616
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 HILLSBORO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62025-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-624-4060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.019922 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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