Provider Demographics
NPI:1295393700
Name:CROSSMAN, LORI KAYE (LMSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAYE
Last Name:CROSSMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 MONTY DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8085
Mailing Address - Country:US
Mailing Address - Phone:616-430-7868
Mailing Address - Fax:
Practice Address - Street 1:8901 MONTY DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8085
Practice Address - Country:US
Practice Address - Phone:616-430-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801106551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical