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General NPI Number Information
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NPI Number | 1063902740
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Entity Type | Individual
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Provider Name | CARLA ALEXANDRA LOURENCO PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 52 OBERY ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-2199
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Country | US
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Telephone | 508-685-1802
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Fax |
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Provider Business Mailing Address
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Address Line | 38 KENSINGTON
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City | PLYMOUTH
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State | MA
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Zip | 02360-3179
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Country | US
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Telephone | 508-685-1802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 9049
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License Number State | MA
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