Provider Demographics
NPI:1972661940
Name:DEMERCHANT, LORI L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:DEMERCHANT
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 1:218 W PRESQUE ISLE RD
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-4113
Mailing Address - Country:US
Mailing Address - Phone:207-493-4770
Mailing Address - Fax:
Practice Address - Street 1:34 NORTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2264
Practice Address - Country:US
Practice Address - Phone:207-768-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC115521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098153OtherANTHEM BCBS NUMBER
ME431481499Medicaid