Provider Demographics
NPI:1417388976
Name:KEAN-VAUGHN, LORINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LORINE
Middle Name:
Last Name:KEAN-VAUGHN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:LORINE
Other - Middle Name:
Other - Last Name:ROBERTSON-KEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2027 ROMAN CT
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2185
Mailing Address - Country:US
Mailing Address - Phone:158-657-3407
Mailing Address - Fax:158-657-3705
Practice Address - Street 1:2027 ROMAN CT
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2185
Practice Address - Country:US
Practice Address - Phone:586-573-4077
Practice Address - Fax:586-573-7050
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010721391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical