Doctor Name: | DR. LAURA ANNE BRODIE |
NPI Number: | 1063611341 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY14511 |
Business Practice Address: | 17662 Irvine Blvd Suite 11 Tustin, CA - 927803149 |
Business Phone Number: | 7147307090 |
Business Fax Number: | 7147317119 |
Mailing Address: | 17662 Irvine Blvd, Suite 11 TUSTIN |
State: | CA |
Postal Code: | 927803149 |
Phone Number: | 7147307090 |
Fax Number: | 7147317119 |
NPI Enumeration Date: | 07/16/2007 |
NPI Last Update Date: | 07/16/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY14511 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |