Provider Demographics
NPI:1932182904
Name:PINK, LORI D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:D
Last Name:PINK
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 1:7500 NW 5TH ST
Mailing Address - Street 2:STE 111
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1612
Mailing Address - Country:US
Mailing Address - Phone:954-584-6478
Mailing Address - Fax:954-797-4911
Practice Address - Street 1:7500 NW 5TH ST
Practice Address - Street 2:STE 111
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1612
Practice Address - Country:US
Practice Address - Phone:954-584-6478
Practice Address - Fax:954-797-4911
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6418Medicare ID - Type Unspecified