Provider Demographics
NPI:1093839649
Name:STURGIS, LAURA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:STURGIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 EAST MANOA ROAD
Mailing Address - Street 2:SUITE 1-203
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1858
Mailing Address - Country:US
Mailing Address - Phone:808-988-6168
Mailing Address - Fax:808-955-8155
Practice Address - Street 1:2851 E MANOA RD
Practice Address - Street 2:SUITE 1-203
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1858
Practice Address - Country:US
Practice Address - Phone:808-988-6168
Practice Address - Fax:808-955-8155
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY- 375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA03223-3Medicaid
HI0000032235OtherHMSA
HIA03223-3Medicaid