Healthcare Provider Details

I. General information

NPI: 1104097278
Provider Name (Legal Business Name): LORRAINE WISEMAN CMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE
MEMPHIS TN
38104-2127
US

IV. Provider business mailing address

7171 BLUEGRASS RD
OLIVE BRANCH MS
38654-1008
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax:
Mailing address:
  • Phone: 662-895-4630
  • Fax: 901-516-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5448
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: