Provider Demographics
NPI:1811331739
Name:MOORHEAD, LORI RIGGIO (PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:RIGGIO
Last Name:MOORHEAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:BETH
Other - Last Name:RIGGIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5369 CAMDEN AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5809
Mailing Address - Country:US
Mailing Address - Phone:408-220-3576
Mailing Address - Fax:
Practice Address - Street 1:5369 CAMDEN AVE STE 230
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5809
Practice Address - Country:US
Practice Address - Phone:408-220-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist