Provider Demographics
NPI:1023554961
Name:MESSINA, LOREN ASHLEY
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:ASHLEY
Last Name:MESSINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 PALOS VERDES BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6331
Mailing Address - Country:US
Mailing Address - Phone:914-400-7448
Mailing Address - Fax:
Practice Address - Street 1:11609 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:LAKE VIEW TERRACE
Practice Address - State:CA
Practice Address - Zip Code:91342-6607
Practice Address - Country:US
Practice Address - Phone:818-485-5727
Practice Address - Fax:818-979-0428
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)