Provider Demographics
NPI:1619031309
Name:OREND, LORI DIANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:DIANE
Last Name:OREND
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 1:401 WEST THAMES STREET
Mailing Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-859-4760
Mailing Address - Fax:860-859-4672
Practice Address - Street 1:401 WEST THAMES STREET
Practice Address - Street 2:SOUTHEASTERN MENTAL HEALTH AUTHORITY BLDG 301
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-859-4760
Practice Address - Fax:860-859-4672
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004950104100000X
CT49501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002638Medicare ID - Type UnspecifiedFIRST COAST