Healthcare Provider Details

I. General information

NPI: 1235535618
Provider Name (Legal Business Name): LORI ANN CLOSE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300B SCHOLLS LN
FREDERICK MD
21701-6380
US

IV. Provider business mailing address

350 MONTEVUE LN
FREDERICK MD
21702-8214
US

V. Phone/Fax

Practice location:
  • Phone: 301-600-1775
  • Fax: 301-600-1781
Mailing address:
  • Phone: 301-600-1029
  • Fax: 301-600-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17724
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: