Provider Demographics
NPI:1396706420
Name:DORSEY, LORI (LICSW,LCDP,LCDCS,CCJ)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:LICSW,LCDP,LCDCS,CCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PILGRIM DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1108
Mailing Address - Country:US
Mailing Address - Phone:401-225-1525
Mailing Address - Fax:
Practice Address - Street 1:900 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4417
Practice Address - Country:US
Practice Address - Phone:401-225-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDS00028101YA0400X
RIISW011791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406743OtherBLUE CHIP
RI23114-9OtherBLUE CROSS