Provider Demographics
NPI:1083699557
Name:FORSYTH, LAURA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:FORSYTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CARMEN DR
Mailing Address - Street 2:STE. 211
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3105
Mailing Address - Country:US
Mailing Address - Phone:805-795-2131
Mailing Address - Fax:805-322-2103
Practice Address - Street 1:1601 CARMEN DR
Practice Address - Street 2:STE. 211
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3105
Practice Address - Country:US
Practice Address - Phone:805-795-2131
Practice Address - Fax:805-322-2103
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17938103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11701672OtherCAQH
CAOPL 179380OtherBLUE SHIELD
CAOPL 179380OtherBLUE SHIELD