Provider Demographics
NPI:1578882148
Name:LORE, RAVINN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAVINN
Middle Name:S
Last Name:LORE
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 1:3235 N BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3649
Mailing Address - Country:US
Mailing Address - Phone:562-420-7315
Mailing Address - Fax:
Practice Address - Street 1:3235 N BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3649
Practice Address - Country:US
Practice Address - Phone:562-420-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health