Provider Demographics
NPI:1750620498
Name:PRINCE, LORI (LCSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 PASADENA AVE S STE 311
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2856
Mailing Address - Country:US
Mailing Address - Phone:727-458-9506
Mailing Address - Fax:
Practice Address - Street 1:1135 PASADENA AVE S STE 311
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-2856
Practice Address - Country:US
Practice Address - Phone:727-458-9506
Practice Address - Fax:954-944-2019
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW29641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical