Provider Demographics
NPI:1093867111
Name:LAFFERTY, PATRICIA (PH D)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 WILSHIRE BLVD STE 740
Mailing Address - Street 2:
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4325
Mailing Address - Country:US
Mailing Address - Phone:310-208-1151
Mailing Address - Fax:310-475-3955
Practice Address - Street 1:10850 WILSHIRE BLVD STE 740
Practice Address - Street 2:
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90024-4325
Practice Address - Country:US
Practice Address - Phone:310-208-1151
Practice Address - Fax:310-475-3955
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11216103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical