Provider Demographics
NPI:1700607595
Name:LOHR, JEANETTE MARIE BASIRICO (LEP)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MARIE BASIRICO
Last Name:LOHR
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 9TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4412
Mailing Address - Country:US
Mailing Address - Phone:909-528-9128
Mailing Address - Fax:
Practice Address - Street 1:301 9TH ST STE 215
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4412
Practice Address - Country:US
Practice Address - Phone:909-528-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist