Provider Demographics
NPI:1215106505
Name:LORI PINK, LCSW, PA
Entity type:Organization
Organization Name:LORI PINK, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PINK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-584-6478
Mailing Address - Street 1:950 S PINE ISLAND RD STE 150A
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3918
Mailing Address - Country:US
Mailing Address - Phone:954-584-6478
Mailing Address - Fax:954-797-4911
Practice Address - Street 1:950 S PINE ISLAND RD STE 150A
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3918
Practice Address - Country:US
Practice Address - Phone:954-584-6478
Practice Address - Fax:954-797-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW38181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6418BMedicare UPIN