Provider Demographics
NPI:1942417076
Name:LORRAINE, BARBARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:LORRAINE
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 1:4041 RIDGE AVE APT 18510
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1557
Mailing Address - Country:US
Mailing Address - Phone:215-779-0611
Mailing Address - Fax:215-487-1990
Practice Address - Street 1:6012 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19128-1643
Practice Address - Country:US
Practice Address - Phone:215-487-1990
Practice Address - Fax:215-487-1992
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006962L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA735719Medicare ID - Type Unspecified