Provider Demographics
NPI:1891263018
Name:REVITZ, LORI BETH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:REVITZ
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 ARGONNE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1943
Mailing Address - Country:US
Mailing Address - Phone:410-889-5054
Mailing Address - Fax:410-889-2356
Practice Address - Street 1:801 ARGONNE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1943
Practice Address - Country:US
Practice Address - Phone:410-889-5054
Practice Address - Fax:410-889-2356
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD035761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical