Provider Demographics
NPI:1487094546
Name:GLASS, LORRI LYNN (PHD, LCSW, ACSW)
Entity type:Individual
Prefix:DR
First Name:LORRI
Middle Name:LYNN
Last Name:GLASS
Suffix:
Gender:F
Credentials:PHD, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 CALUMET AVE
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2821
Mailing Address - Country:US
Mailing Address - Phone:121-967-8805
Mailing Address - Fax:
Practice Address - Street 1:9245 CALUMET AVE
Practice Address - Street 2:SUITE 101B
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2821
Practice Address - Country:US
Practice Address - Phone:121-967-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001799A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical