Provider Demographics
NPI:1205615614
Name:STEPHANIE LORD, PHD, CLINICAL PSYCHOLOGIST INC
Entity type:Organization
Organization Name:STEPHANIE LORD, PHD, CLINICAL PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-215-1432
Mailing Address - Street 1:7040 AVENIDA ENCINAS STE 104-116
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4652
Mailing Address - Country:US
Mailing Address - Phone:858-215-1432
Mailing Address - Fax:
Practice Address - Street 1:7040 AVENIDA ENCINAS STE 104-116
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4652
Practice Address - Country:US
Practice Address - Phone:858-215-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty