Provider Demographics
NPI:1104170083
Name:MEAD, LORETTA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 E KINGSLEY AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-242-0591
Mailing Address - Fax:
Practice Address - Street 1:7901 PAINTER AVE
Practice Address - Street 2:STE 4
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2401
Practice Address - Country:US
Practice Address - Phone:909-242-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical