Provider Demographics
NPI:1588397913
Name:LORING, AMY ELIZABETH (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:LORING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8221 65TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5564
Mailing Address - Country:US
Mailing Address - Phone:509-481-3653
Mailing Address - Fax:
Practice Address - Street 1:8221 65TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5564
Practice Address - Country:US
Practice Address - Phone:509-481-3653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611755451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty