Provider Demographics
NPI:1417189382
Name:MAKOS, LORI A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:MAKOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32-36 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1840
Mailing Address - Country:US
Mailing Address - Phone:570-723-0574
Mailing Address - Fax:570-723-5072
Practice Address - Street 1:114 EAST AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1737
Practice Address - Country:US
Practice Address - Phone:570-723-0620
Practice Address - Fax:570-724-0675
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0172871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical