MEDICARE: LORRAINE HALEY LMSW

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	6801093504	MI

General Provider Information

NPI Number	:	1043626344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE HALEY LMSW

Provider Business Mailing Address
First Line	:	PO BOX 483
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48707-0483
Country	:	US
Telephone Number	:	989-450-5710
Fax Number	:	989-894-8051

Provider Business Practice Location Address
First Line	:	1308 COLUMBUS AVE
Second Line	:	STE 102
City	:	BAY CITY
State	:	MI
Zip	:	48708-6671
Country	:	US
Telephone Number	:	989-980-4872
Fax Number	:	989-894-8051

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	12/04/2015

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