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General NPI Number Information
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NPI Number | 1679523922
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Entity Type | Individual
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Provider Name | LORETTA MARIE LOWERY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3356 2ND AVE SUITE C
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City | SAN DIEGO
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State | CA
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Zip | 92103-5636
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Country | US
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Telephone | 619-980-6238
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Fax | 619-294-3107
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Provider Business Mailing Address
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Address Line | PO BOX 12202
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City | LA JOLLA
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State | CA
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Zip | 92039-2202
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Country | US
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Telephone | 619-980-6238
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Fax | 619-294-3107
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19709
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License Number State | CA
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