Provider Demographics
NPI:1982995189
Name:BLUMENSTEIN-BOTT, LORI BETH (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:BLUMENSTEIN-BOTT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6474 PINECROFT DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2245
Mailing Address - Country:US
Mailing Address - Phone:248-538-0250
Mailing Address - Fax:
Practice Address - Street 1:6474 PINECROFT DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2245
Practice Address - Country:US
Practice Address - Phone:248-568-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801021179104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker