Provider Demographics
NPI:1689019630
Name:LIPORI, LARAINE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LARAINE
Middle Name:MARIE
Last Name:LIPORI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3429 MERRIMAC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-1719
Mailing Address - Country:US
Mailing Address - Phone:858-775-6702
Mailing Address - Fax:760-944-7491
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:858-775-6702
Practice Address - Fax:760-944-7491
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical