Provider Demographics
NPI:1619003423
Name:LANCASTER, KATHY ELIZABETH (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ELIZABETH
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NORTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2301
Mailing Address - Country:US
Mailing Address - Phone:586-783-2950
Mailing Address - Fax:586-690-4333
Practice Address - Street 1:100 NORTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2301
Practice Address - Country:US
Practice Address - Phone:586-783-2950
Practice Address - Fax:586-690-4333
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJ648884104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker