Provider Demographics
NPI:1912789983
Name:BATEMAN, LORI (LICSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BATEMAN
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 1:153 EQUESTRIAN LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-4224
Mailing Address - Country:US
Mailing Address - Phone:850-543-6578
Mailing Address - Fax:
Practice Address - Street 1:153 EQUESTRIAN LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-4224
Practice Address - Country:US
Practice Address - Phone:850-543-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5260C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical