Healthcare Provider Details

I. General information

NPI: 1861787863
Provider Name (Legal Business Name): LORI ANNE BARKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 BROCKTON AVE
RIVERSIDE CA
92506-2228
US

IV. Provider business mailing address

6180 BROCKTON AVE
RIVERSIDE CA
92506-2228
US

V. Phone/Fax

Practice location:
  • Phone: 909-539-8955
  • Fax: 951-788-7075
Mailing address:
  • Phone: 909-539-8955
  • Fax: 951-788-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 14290
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 14290
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 14290
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 14290
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: