Provider Demographics
NPI:1386903482
Name:LORI SARVIS , LCSW PA
Entity type:Organization
Organization Name:LORI SARVIS , LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, PA
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-426-0410
Mailing Address - Street 1:2151 W HILLSBORO BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1275
Mailing Address - Country:US
Mailing Address - Phone:954-426-0410
Mailing Address - Fax:954-596-4822
Practice Address - Street 1:2151 W HILLSBORO BLVD STE 203
Practice Address - Street 2:
Practice Address - City:DEERFIELD BCH
Practice Address - State:FL
Practice Address - Zip Code:33442-1275
Practice Address - Country:US
Practice Address - Phone:954-426-0410
Practice Address - Fax:954-596-4822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0002627305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization