Provider Demographics
NPI:1346616166
Name:GORDON-MICHAELI, LORI ELLEN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELLEN
Last Name:GORDON-MICHAELI
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 1:26342 DUNDALK ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4812
Mailing Address - Country:US
Mailing Address - Phone:248-225-8240
Mailing Address - Fax:
Practice Address - Street 1:29623 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1076
Practice Address - Country:US
Practice Address - Phone:248-225-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-16
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010951731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical