Provider Demographics
NPI:1811268824
Name:LOURIA, SHIRA R (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHIRA
Middle Name:R
Last Name:LOURIA
Suffix:
Gender:F
Credentials:PSYD
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Mailing Address - Street 1:111 COLCHESTER AVE.
Mailing Address - Street 2:UVM MEDICAL CENTER, DEPT. OF PSYCHIATRY
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-3634
Mailing Address - Fax:802-847-8961
Practice Address - Street 1:111 COLCHESTER AVE.
Practice Address - Street 2:UVM MEDICAL CENTER, DEPT. OF PSYCHIATRY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-3634
Practice Address - Fax:802-847-8961
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT048.0083762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT048.0083762OtherLICENSE