Provider Demographics
NPI:1790002061
Name:CHURCHILL, LORI M (LICSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:CHURCHILL
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 1:26 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01452-1440
Mailing Address - Country:US
Mailing Address - Phone:978-928-1164
Mailing Address - Fax:
Practice Address - Street 1:53 GARDNER RD
Practice Address - Street 2:
Practice Address - City:HUBBARDSTON
Practice Address - State:MA
Practice Address - Zip Code:01452-1650
Practice Address - Country:US
Practice Address - Phone:978-928-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical