Provider Demographics
NPI:1023174364
Name:JANSSEN, LORI ELAINE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ELAINE
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MADARY RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1211
Mailing Address - Country:US
Mailing Address - Phone:410-647-1069
Mailing Address - Fax:
Practice Address - Street 1:611 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3941
Practice Address - Country:US
Practice Address - Phone:410-234-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD226525OtherVALUE OPTIONS