Provider Demographics
NPI:1225454572
Name:BADACH, LORI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:BADACH
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 1:2240 NORTH FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221
Mailing Address - Country:US
Mailing Address - Phone:716-308-7056
Mailing Address - Fax:716-529-0003
Practice Address - Street 1:2240 NORTH FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-308-7056
Practice Address - Fax:716-529-0003
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR071801-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical