Provider Demographics
NPI:1043626344
Name:HALEY, LORRAINE (LMSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48707-0483
Mailing Address - Country:US
Mailing Address - Phone:989-450-5710
Mailing Address - Fax:989-894-8051
Practice Address - Street 1:1308 COLUMBUS AVE
Practice Address - Street 2:STE 102
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6671
Practice Address - Country:US
Practice Address - Phone:989-980-4872
Practice Address - Fax:989-894-8051
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010935041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G96288Medicare UPIN