Provider Demographics
NPI:1033345574
Name:LOREFICE, MARY ELLEN FOULDS (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:FOULDS
Last Name:LOREFICE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BALLWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870
Mailing Address - Country:US
Mailing Address - Phone:203-637-0842
Mailing Address - Fax:203-637-8052
Practice Address - Street 1:39 BALLWOOD ROAD
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870
Practice Address - Country:US
Practice Address - Phone:203-637-0842
Practice Address - Fax:203-637-8052
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical