Provider Demographics
NPI:1831607597
Name:PRESTON, LORI BG (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BG
Last Name:PRESTON
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 1:81 GREEN ST APT 26
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3317
Mailing Address - Country:US
Mailing Address - Phone:617-388-4663
Mailing Address - Fax:
Practice Address - Street 1:81 GREEN ST APT 26
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3317
Practice Address - Country:US
Practice Address - Phone:617-388-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker