Provider Demographics
NPI:1255739736
Name:SPEAKE, LORA (LCSW-C)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:SPEAKE
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 1:4502 SCHENLEY RD # 100A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2524
Mailing Address - Country:US
Mailing Address - Phone:433-308-3032
Mailing Address - Fax:
Practice Address - Street 1:4502 SCHENLEY RD # 100A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2524
Practice Address - Country:US
Practice Address - Phone:433-308-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker