Provider Demographics
NPI:1023382322
Name:BAKER-GURVITCH, LORI REBECCA (LCSW-C; LICSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:REBECCA
Last Name:BAKER-GURVITCH
Suffix:
Gender:F
Credentials:LCSW-C; LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LOCKS POND CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2983
Mailing Address - Country:US
Mailing Address - Phone:240-687-5804
Mailing Address - Fax:
Practice Address - Street 1:18 LOCKS POND CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2983
Practice Address - Country:US
Practice Address - Phone:240-687-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-04
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3019731041C0700X
MD053151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical