Provider Demographics
NPI:1831446988
Name:SPARROW, LORI SMITH
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:SMITH
Last Name:SPARROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 JUNIPERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1252
Mailing Address - Country:US
Mailing Address - Phone:415-518-4186
Mailing Address - Fax:
Practice Address - Street 1:555 NORTHGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3696
Practice Address - Country:US
Practice Address - Phone:415-491-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health