Healthcare Provider Details

I. General information

NPI: 1881739175
Provider Name (Legal Business Name): DAVID LORENTZEN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 N EUCLID AVE STE 500
PASADENA CA
91101-1468
US

IV. Provider business mailing address

299 N EUCLID AVE STE 500
PASADENA CA
91101-1468
US

V. Phone/Fax

Practice location:
  • Phone: 626-209-9747
  • Fax:
Mailing address:
  • Phone: 818-523-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 23226
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 23226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: