Provider Demographics
NPI:1730590514
Name:JOSEPH, LORRAINE SARESA (LMFT)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:SARESA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:SARESA
Other - Last Name:CAUSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:9191 GRAMERCY ST.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:909-938-6722
Mailing Address - Fax:
Practice Address - Street 1:2247 SAN DIEGO AVENUE
Practice Address - Street 2:#136
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:858-205-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT31206106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist