Provider Demographics
NPI:1356454573
Name:GATO, LORI-ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI-ANN
Middle Name:
Last Name:GATO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORI-ANN
Other - Middle Name:
Other - Last Name:BOUTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2316
Mailing Address - Country:US
Mailing Address - Phone:207-842-6540
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:200 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8434
Practice Address - Country:US
Practice Address - Phone:207-883-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 115321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432212699Medicaid
ME000904603Medicare PIN