Provider Demographics
NPI:1609991918
Name:BANK, LORITA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:LORITA
Middle Name:L
Last Name:BANK
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 1:155 BOVET RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3108
Mailing Address - Country:US
Mailing Address - Phone:650-212-2265
Mailing Address - Fax:650-375-0294
Practice Address - Street 1:155 BOVET RD
Practice Address - Street 2:SUITE 404
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3108
Practice Address - Country:US
Practice Address - Phone:650-212-2265
Practice Address - Fax:650-375-0294
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL87320Medicare UPIN