Provider Demographics
NPI:1770176430
Name:LUBBERS, LORI RENAE (LICSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:RENAE
Last Name:LUBBERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16569 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-6588
Mailing Address - Country:US
Mailing Address - Phone:269-254-5629
Mailing Address - Fax:
Practice Address - Street 1:16569 S WALL ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-6588
Practice Address - Country:US
Practice Address - Phone:269-254-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605719601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical