Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY20741 | CA |
N | 103T00000X | Psychologist | PSY20741 | CA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY20741 | CA |
NPI | 1124145263 |
---|---|
Provider Name | Elizabeth Laugeson |
First Address | Los Angeles, CA 90045-5632 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 06/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY207410 | (05) | CA |