Provider Demographics
NPI:1437622115
Name:LAUVER-TOBIN, LORAINE J (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:J
Last Name:LAUVER-TOBIN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1863
Mailing Address - Country:US
Mailing Address - Phone:920-458-5557
Mailing Address - Fax:
Practice Address - Street 1:3425 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1863
Practice Address - Country:US
Practice Address - Phone:920-458-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2601-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2601-123OtherSOCIAL WORKER CLINICAL