Provider Demographics
NPI:1003057472
Name:MATHES, LORRAINE (BSLBSW)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:MATHES
Suffix:
Gender:F
Credentials:BSLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 OAKWOOD BLVD. #3
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-561-1776
Mailing Address - Fax:
Practice Address - Street 1:1270 DORIS RD.
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326
Practice Address - Country:US
Practice Address - Phone:248-276-8159
Practice Address - Fax:248-276-9833
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802057967104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker