MEDICARE: GREGORY LOTT CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801083237	MI

General Provider Information

NPI Number	:	1548226202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LOTT CSW

Provider Business Mailing Address
First Line	:	830 W LAKE LANSING RD STE 200
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6372
Country	:	US
Telephone Number	:	517-624-1416
Fax Number	:	517-237-4170

Provider Business Practice Location Address
First Line	:	3960 PATIENT CARE WAY
Second Line	:	STE 101
City	:	LANSING
State	:	MI
Zip	:	48911-4275
Country	:	US
Telephone Number	:	517-882-3732
Fax Number	:	517-882-3633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	08/23/2023

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