Provider Demographics
NPI:1073829867
Name:MASE, LORI LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNN
Last Name:MASE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:450 NEWPORT CENTER DRIVE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7641
Mailing Address - Country:US
Mailing Address - Phone:949-378-8550
Mailing Address - Fax:949-999-8365
Practice Address - Street 1:450 NEWPORT CENTER DRIVE
Practice Address - Street 2:SUITE #650
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7461
Practice Address - Country:US
Practice Address - Phone:949-644-5800
Practice Address - Fax:949-999-8365
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46845106H00000X
CA46845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist