Provider Demographics
NPI:1932505088
Name:LORETTA MEAD PSYCHOLOGY INC
Entity Type:Organization
Organization Name:LORETTA MEAD PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-242-5409
Mailing Address - Street 1:25930 YANEZ TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-2101
Mailing Address - Country:US
Mailing Address - Phone:909-242-5409
Mailing Address - Fax:
Practice Address - Street 1:5005 LA MART DR
Practice Address - Street 2:STE 100-B10
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5952
Practice Address - Country:US
Practice Address - Phone:909-242-5409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty