Provider Demographics
NPI:1023182524
Name:LONDON, LORNA HELENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:HELENE
Last Name:LONDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6643
Mailing Address - Country:US
Mailing Address - Phone:630-983-0977
Mailing Address - Fax:630-375-2812
Practice Address - Street 1:643 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6643
Practice Address - Country:US
Practice Address - Phone:630-983-0977
Practice Address - Fax:630-375-2812
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232024OtherBCBS-PPO
IL0002232024OtherBCBS-PPO