Provider Demographics
NPI:1881115244
Name:IOCOLANO, LORRAINE ROSE (LMFT)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ROSE
Last Name:IOCOLANO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 N GAFFEY ST STE I
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-1268
Mailing Address - Country:US
Mailing Address - Phone:424-264-5288
Mailing Address - Fax:
Practice Address - Street 1:1891 N GAFFEY ST STE I
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-1268
Practice Address - Country:US
Practice Address - Phone:424-264-5288
Practice Address - Fax:310-634-0370
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108809106H00000X, 101YM0800X
225400000X, 390200000X
CA125786106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health