Provider Demographics
NPI:1417911785
Name:SHALLCROSS, LORI T (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:T
Last Name:SHALLCROSS
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 1:1450 BONNIE BURN CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5703
Mailing Address - Country:US
Mailing Address - Phone:352-394-5922
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:655 W HWY 50
Practice Address - Street 2:SUITE 104
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2913
Practice Address - Country:US
Practice Address - Phone:352-394-5922
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 66751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ090NOtherBLUE CROSS BLUE SHIELD #