Provider Demographics
NPI:1508250200
Name:FAHY, LOREE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LOREE
Middle Name:
Last Name:FAHY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SANTA MONICA BLVD
Mailing Address - Street 2:STE. 224
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1632
Mailing Address - Country:US
Mailing Address - Phone:310-795-0766
Mailing Address - Fax:310-230-3059
Practice Address - Street 1:610 SANTA MONICA BLVD
Practice Address - Street 2:STE. 224
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1632
Practice Address - Country:US
Practice Address - Phone:310-795-0766
Practice Address - Fax:310-230-3059
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist