Provider Demographics
NPI:1407521479
Name:ROLF, LORI BETH (LICSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:ROLF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 EMERSON AVE S APT 109
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2307
Mailing Address - Country:US
Mailing Address - Phone:612-226-4020
Mailing Address - Fax:
Practice Address - Street 1:2832 EMERSON AVE S APT 109
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2307
Practice Address - Country:US
Practice Address - Phone:612-226-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN190651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical