Provider Demographics
NPI:1821019266
Name:BANCROFT, LORRA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LORRA
Middle Name:
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2513
Mailing Address - Country:US
Mailing Address - Phone:989-773-9328
Mailing Address - Fax:989-773-9803
Practice Address - Street 1:118 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2513
Practice Address - Country:US
Practice Address - Phone:989-773-9328
Practice Address - Fax:989-773-9803
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680107331371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801073137OtherLICENSE NUMBER