Provider Demographics
NPI:1598050270
Name:GEISELMAN, LORI ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:GEISELMAN
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 1:112 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-1524
Mailing Address - Country:US
Mailing Address - Phone:401-724-4066
Mailing Address - Fax:
Practice Address - Street 1:112 PINECREST DR
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-1524
Practice Address - Country:US
Practice Address - Phone:401-724-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW017661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical