Provider Demographics
NPI:1255497384
Name:SUTTON, LAURIE D (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:D
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 SAWTELLE BLVD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4926
Mailing Address - Country:US
Mailing Address - Phone:310-477-0771
Mailing Address - Fax:310-473-6912
Practice Address - Street 1:1850 SAWTELLE BLVD.
Practice Address - Street 2:SUITE 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4926
Practice Address - Country:US
Practice Address - Phone:310-477-0771
Practice Address - Fax:310-473-6912
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS186821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 18682OtherCALIF. BOARD OF BEHAVIORAL SCIENCE