Provider Demographics
NPI:1295183754
Name:BROWN, LAURIE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:MCKNIGHT BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5405 E VILLAGE RD
Mailing Address - Street 2:#8650
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-7030
Mailing Address - Country:US
Mailing Address - Phone:562-708-8727
Mailing Address - Fax:
Practice Address - Street 1:5199 E PACIFIC COAST HWY
Practice Address - Street 2:330N
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3309
Practice Address - Country:US
Practice Address - Phone:562-708-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical