Provider Demographics
NPI:1144294729
Name:LOREN, RICHARD (PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LOREN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7068 SPRUCE HILL CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3638
Mailing Address - Country:US
Mailing Address - Phone:513-520-1761
Mailing Address - Fax:513-636-0755
Practice Address - Street 1:3333 BURNET AVE ML 10006
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-8515
Practice Address - Fax:513-636-0755
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV839103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9203064000Medicaid
WV9203064000Medicaid
WVLOCP28422Medicare ID - Type Unspecified