Provider Demographics
NPI:1255562385
Name:NISSON, LORI E (MSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:E
Last Name:NISSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:N
Other - Last Name:WALDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9369 E DAVENPORT DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7419
Mailing Address - Country:US
Mailing Address - Phone:602-570-6788
Mailing Address - Fax:480-767-7220
Practice Address - Street 1:9369 E DAVENPORT DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7419
Practice Address - Country:US
Practice Address - Phone:602-570-6788
Practice Address - Fax:480-767-7220
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 110321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical