Provider Demographics
NPI:1629308267
Name:LOWENTHAL, TRACI WARNER (TRACI LOWENTHAL)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:WARNER
Last Name:LOWENTHAL
Suffix:
Gender:F
Credentials:TRACI LOWENTHAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0241
Mailing Address - Country:US
Mailing Address - Phone:909-240-7833
Mailing Address - Fax:
Practice Address - Street 1:250 W 1ST ST STE 340
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4751
Practice Address - Country:US
Practice Address - Phone:909-240-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22910103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist