DR. COLETTE LORD, PH.D. - NPI NUMBER 1184790933

Summary

Provider Name: DR. COLETTE LORD, PH.D.

NPI Number: 1184790933

Clasification: Psychologist (103TC0700X)

Specialization: Clinical

Organization: COMMUNITY RESEARCH FOUNDATION INC

Address:
1568 6TH AVE
SAN DIEGO, CA
ZIP 92101

Phone Number: (619) 235-2600



Detailed Information

DR. Colette Lord, PH.D. is a clinical psychologist in San Diego, CA with 9 years of experience. The assigned NPI number for this provider is 1184790933 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

1568 6TH AVE
SAN DIEGO, CA
ZIP 92101-216
Phone: (619) 235-2600
Fax: (619) 235-2617

The enumeration date for this NPI number is 11/24/2006 and was last updated on 3/7/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103TC0700X Psychologist Clinical PSY 21497 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 WCP21497A MEDICARE PIN CA

NPI Record

No. Field Name Field Value
1 NPI 1184790933
2 Entity Type Code 1
3 Provider Last Name Legal Name LORD
4 Provider First Name COLETTE
5 Provider Name Prefix Text DR.
6 Provider Credential Text PH.D.
7 Provider First Line Business Practice Location Address 1568 6TH AVE
8 Provider Business Practice Location Address City Name SAN DIEGO
9 Provider Business Practice Location Address State Name CA
10 Provider Business Practice Location Address Postal Code 921013216
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 6192352600
13 Provider Business Practice Location Address Fax Number 6192352617
14 Provider Enumeration Date 11/24/2006
15 Last Update Date 3/7/2011
16 Provider Gender Code F
17 Healthcare Provider Taxonomy Code 1 103TC0700X
18 Provider License Number 1 PSY 21497
19 Provider License Number State Code 1 CA
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 WCP21497A
22 Other Provider Identifier Type Code 1 08
23 Other Provider Identifier State 1 CA
24 Is Sole Proprietor N

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.