Provider Demographics
NPI:1174644678
Name:MICHELSON, LORI SAVITT (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:SAVITT
Last Name:MICHELSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N STATE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5024
Mailing Address - Country:US
Mailing Address - Phone:360-303-5124
Mailing Address - Fax:
Practice Address - Street 1:1155 N STATE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5024
Practice Address - Country:US
Practice Address - Phone:360-303-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000054381041C0700X
FLSW47341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8859600Medicare ID - Type UnspecifiedLIC. INDEP. CLINICAL S.W.