Provider Demographics
NPI:1952663577
Name:CHOPRA, LORETTA (MS)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:CHOPRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LORRIE
Other - Middle Name:
Other - Last Name:CHOPRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:37727 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 110-D
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1195
Mailing Address - Country:US
Mailing Address - Phone:734-502-5330
Mailing Address - Fax:
Practice Address - Street 1:37727 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 110-D
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1195
Practice Address - Country:US
Practice Address - Phone:734-502-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI601012268103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist