Provider Demographics
NPI:1851439129
Name:MOSES-BENNETT, LORI G (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:G
Last Name:MOSES-BENNETT
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:PO BOX 4174
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80306-4174
Mailing Address - Country:US
Mailing Address - Phone:303-709-7601
Mailing Address - Fax:303-665-5501
Practice Address - Street 1:1634 WALNUT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5400
Practice Address - Country:US
Practice Address - Phone:303-709-7601
Practice Address - Fax:303-665-5501
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9929691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical