Provider Demographics
NPI:1730481284
Name:LORENC, BRADY (LMSW)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:LORENC
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 W POPPY LN
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-5201
Mailing Address - Country:US
Mailing Address - Phone:417-848-8515
Mailing Address - Fax:
Practice Address - Street 1:3820 W POPPY LN
Practice Address - Street 2:
Practice Address - City:BATTLEFIELD
Practice Address - State:MO
Practice Address - Zip Code:65619-5201
Practice Address - Country:US
Practice Address - Phone:417-848-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker