Healthcare Provider Details

I. General information

NPI: 1083319685
Provider Name (Legal Business Name): LORI SHIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI HELENE BERMES

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 ALDER AVE
CARLSBAD CA
92008-2704
US

IV. Provider business mailing address

3815 ALDER AVE
CARLSBAD CA
92008-2704
US

V. Phone/Fax

Practice location:
  • Phone: 610-608-5053
  • Fax:
Mailing address:
  • Phone: 610-608-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: