Provider Demographics
NPI:1992307128
Name:LLOYD, LARRAINE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:MRS
First Name:LARRAINE
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 WARNER AVE # 339
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:800-273-4292
Mailing Address - Fax:714-596-6274
Practice Address - Street 1:2535 CAMINO DEL RIO S STE 155
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3762
Practice Address - Country:US
Practice Address - Phone:800-273-4292
Practice Address - Fax:714-596-6274
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-48134103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst