Provider Demographics
NPI:1154354611
Name:FUTTERMAN, LORI A (PHD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:FUTTERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 CAMINO DE LA REINA STE 705
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3109
Mailing Address - Country:US
Mailing Address - Phone:619-297-3311
Mailing Address - Fax:619-294-3322
Practice Address - Street 1:591 CAMINO DE LA REINA STE 705
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3109
Practice Address - Country:US
Practice Address - Phone:619-297-3311
Practice Address - Fax:619-294-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8636103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical