Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY 17938 | CA |
NPI | 1083699557 |
---|---|
Provider Name | Dr. Laura E. Forsyth |
First Address | Camarillo, CA 93010-3105 |
Second Address | Camarillo, CA 93010-3105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 23/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11701672 | CAQH (01) | CA |
AU749Z | (02) | CA |
OPL 179380 | BLUE SHIELD (01) | CA |