Healthcare Provider Details

I. General information

NPI: 1316374036
Provider Name (Legal Business Name): LORENE MARIE PETTA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 E GREENWAY PKWY STE 100-587
SCOTTSDALE AZ
85254-2045
US

IV. Provider business mailing address

PO BOX 4622
SCOTTSDALE AZ
85261-4622
US

V. Phone/Fax

Practice location:
  • Phone: 480-203-0403
  • Fax:
Mailing address:
  • Phone: 480-203-0403
  • Fax: 480-256-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4435
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: