Provider Demographics
NPI:1992862387
Name:LINN, LORI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:LINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:LINN
Other - Last Name:PELE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4603 MISSION BLVD STE 217
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2793
Mailing Address - Country:US
Mailing Address - Phone:619-379-8482
Mailing Address - Fax:
Practice Address - Street 1:4603 MISSION BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2793
Practice Address - Country:US
Practice Address - Phone:619-379-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS223871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical