Provider Demographics
NPI:1093284606
Name:CHESLA, LORI ANNE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:CHESLA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 ASH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1925
Mailing Address - Country:US
Mailing Address - Phone:301-357-7170
Mailing Address - Fax:
Practice Address - Street 1:623 W 34TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2658
Practice Address - Country:US
Practice Address - Phone:443-330-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD209721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical