Provider Demographics
NPI:1083767099
Name:SOLLOSE, LORI ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELIZABETH
Last Name:SOLLOSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-0020
Mailing Address - Country:US
Mailing Address - Phone:914-661-0979
Mailing Address - Fax:203-740-0124
Practice Address - Street 1:246 FEDERAL RD STE C35
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2650
Practice Address - Country:US
Practice Address - Phone:914-661-0979
Practice Address - Fax:203-740-0124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055958-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical