Provider Demographics
NPI:1316626674
Name:WHITE, LORISSA A (LICSW)
Entity type:Individual
Prefix:
First Name:LORISSA
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3102
Mailing Address - Country:US
Mailing Address - Phone:612-463-7789
Mailing Address - Fax:612-353-5655
Practice Address - Street 1:2115 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3102
Practice Address - Country:US
Practice Address - Phone:612-463-7789
Practice Address - Fax:612-353-5655
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical