Provider Demographics
NPI:1174254429
Name:AMOS, LORENE (PPS SCHOOL PSYCH)
Entity Type:Individual
Prefix:MS
First Name:LORENE
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:PPS SCHOOL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 PINE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3160
Mailing Address - Country:US
Mailing Address - Phone:951-746-6400
Mailing Address - Fax:
Practice Address - Street 1:379 PINE AVE APT A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3160
Practice Address - Country:US
Practice Address - Phone:951-746-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician