Provider Demographics
NPI:1407050032
Name:RADNER, LORI LYNN (LLP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNN
Last Name:RADNER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37899 W 12 MILE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-6107
Mailing Address - Country:US
Mailing Address - Phone:248-788-6400
Mailing Address - Fax:248-788-3840
Practice Address - Street 1:37899 W 12 MILE RD STE 250
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-6107
Practice Address - Country:US
Practice Address - Phone:248-788-6400
Practice Address - Fax:248-788-3840
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist