Provider Demographics
NPI:1477577062
Name:TEAGNO, LORIE JOYCE (PHD)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:JOYCE
Last Name:TEAGNO
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 1:3262 HOLIDAY COURT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1811
Mailing Address - Country:US
Mailing Address - Phone:858-552-1126
Mailing Address - Fax:858-964-0889
Practice Address - Street 1:3262 HOLIDAY COURT
Practice Address - Street 2:SUITE 200
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1811
Practice Address - Country:US
Practice Address - Phone:858-552-1126
Practice Address - Fax:858-964-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical