Provider Demographics
NPI:1841522349
Name:WORMELY, LORRAINE (LSW,CADC,MISA)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:WORMELY
Suffix:
Gender:F
Credentials:LSW,CADC,MISA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3743 168TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-2155
Mailing Address - Country:US
Mailing Address - Phone:308-362-7313
Mailing Address - Fax:
Practice Address - Street 1:3743 168TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-2155
Practice Address - Country:US
Practice Address - Phone:308-362-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21570101YA0400X, 101YM0800X
IL150.011665104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health