MEDICARE: LORI SARVIS , LCSW PA

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	305R00000X	Preferred Provider Organization	SW0002627	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386903482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORI SARVIS , LCSW PA

Provider Business Mailing Address
First Line	:	2151 W HILLSBORO BLVD STE 203
Second Line	:
City	:	DEERFIELD BCH
State	:	FL
Zip	:	33442-1275
Country	:	US
Telephone Number	:	954-426-0410
Fax Number	:	954-596-4822

Provider Business Practice Location Address
First Line	:	2151 W HILLSBORO BLVD STE 203
Second Line	:
City	:	DEERFIELD BCH
State	:	FL
Zip	:	33442-1275
Country	:	US
Telephone Number	:	954-426-0410
Fax Number	:	954-596-4822

Authorized Official
Title or Position	:	LCSW, PA
Name	:	LORI SARVIS
Credential	:	LCSW
Telephone Number	:	954-426-0410

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	06/06/2019

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