Provider Demographics
NPI:1740711613
Name:HANCOCK, LORI (QMHS)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1874
Mailing Address - Country:US
Mailing Address - Phone:740-485-1978
Mailing Address - Fax:740-522-2941
Practice Address - Street 1:65 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1874
Practice Address - Country:US
Practice Address - Phone:740-485-1978
Practice Address - Fax:740-522-2941
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0287276Medicaid