Active NPI
Lori Renae Lubbers, LICSW
- Clinical Social Worker
- Mount Vernon, WA
National Provider Identifier
1770176430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW60571960
- Practice address
- 16569 S Wall St
Mount Vernon, WA 98273-6588 - Phone
- (269) 254-5629
- NPI assigned
- Feb 14, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW60571960 | WA | Primary |
Addresses
Primary practice location
16569 S Wall St
Mount Vernon, WA 98273-6588
Mailing address
16569 S Wall St
Mount Vernon, WA 98273-6588
Phone (269) 254-5629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LW60571960 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613260800000",
"number": "1770176430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16569 S WALL ST",
"city": "MOUNT VERNON",
"state": "WA",
"postal_code": "982736588",
"telephone_number": "269-254-5629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16569 S WALL ST",
"city": "MOUNT VERNON",
"state": "WA",
"postal_code": "982736588",
"telephone_number": "269-254-5629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUBBERS",
"first_name": "LORI",
"middle_name": "RENAE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-14",
"last_updated": "2021-02-14",
"certification_date": "2021-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW60571960",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.