Provider Demographics
NPI:1821438748
Name:LORI PRINCE LCSW PA
Entity Type:Organization
Organization Name:LORI PRINCE LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-458-9506
Mailing Address - Street 1:1135 PASADENA AVE S STE 311
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2856
Mailing Address - Country:US
Mailing Address - Phone:727-458-9506
Mailing Address - Fax:954-944-2019
Practice Address - Street 1:1135 PASADENA AVE S STE 311
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2856
Practice Address - Country:US
Practice Address - Phone:727-458-9506
Practice Address - Fax:954-944-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW29641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty