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General NPI Number Information
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NPI Number | 1205615614
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Entity Type | Organization
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Legal Business Name | STEPHANIE LORD, PHD, CLINICAL PSYCHOLOGIST INC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 7040 AVENIDA ENCINAS STE 104-116
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City | CARLSBAD
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State | CA
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Zip | 92011-4652
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Country | US
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Telephone | 858-215-1432
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Fax |
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Provider Business Mailing Address
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Address Line | 7040 AVENIDA ENCINAS STE 104-116
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City | CARLSBAD
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State | CA
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Zip | 92011-4652
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Country | US
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Telephone | 858-215-1432
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHANIE LORD
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Credential | PHD
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Telephone | 858-215-1432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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