Provider Demographics
NPI:1033420831
Name:RODRIQUEZ-FLETCHER, LORI R (LICSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:RODRIQUEZ-FLETCHER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-0651
Mailing Address - Country:US
Mailing Address - Phone:308-763-9261
Mailing Address - Fax:308-761-3990
Practice Address - Street 1:221 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3825
Practice Address - Country:US
Practice Address - Phone:308-763-9261
Practice Address - Fax:308-761-3990
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4093101YM0800X
NE14571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical