Provider Demographics
NPI:1093805533
Name:ZAIDEN, LAWRENCE H (PHD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:ZAIDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21201 VICTORY BLVD
Mailing Address - Street 2:SUITE # 250
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2830
Mailing Address - Country:US
Mailing Address - Phone:818-710-1245
Mailing Address - Fax:818-710-1246
Practice Address - Street 1:21201 VICTORY BLVD
Practice Address - Street 2:SUITE # 250
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2830
Practice Address - Country:US
Practice Address - Phone:818-710-1245
Practice Address - Fax:818-710-1246
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP 6537Medicare ID - Type Unspecified