Provider Demographics
NPI:1033730809
Name:LORD, STUART (LMFT)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:LORD
Suffix:
Gender:M
Credentials:LMFT
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 6439
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-0439
Mailing Address - Country:US
Mailing Address - Phone:510-543-8854
Mailing Address - Fax:
Practice Address - Street 1:1221 TALBOT AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94706-2335
Practice Address - Country:US
Practice Address - Phone:510-543-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15429106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT15429OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES (MARRIAGE AND FAMILY THERAPIST LICENSE)