Provider Demographics
NPI:1265718795
Name:STEFANO, LORRAINE (ACSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:STEFANO
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 W BIG BEAVER RD STE 412
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4924
Mailing Address - Country:US
Mailing Address - Phone:248-813-0320
Mailing Address - Fax:
Practice Address - Street 1:755 W BIG BEAVER RD STE 412
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4924
Practice Address - Country:US
Practice Address - Phone:248-813-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker