Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSYC20367 | CA |
Y | 103T00000X | Psychologist | PSYC20367 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSYC20367 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSYC20367 | CA |
N | 103G00000X | Clinical Psychologist | PSYC20367 | CA |
N | 103TC0700X | Clinical Psychologist | PSYC20367 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSYC20367 | CA |
NPI | 1164621660 |
---|---|
Provider Name | Joseph William Labrie |
First Address | Los Angeles, CA 90045-2623 |
Second Address | Los Angeles, CA 90045-2623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 13/07/2007 |