Provider Demographics
NPI:1407264609
Name:LAUE, CARIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARIN
Middle Name:
Last Name:LAUE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 W JEFFERSON BLVD
Mailing Address - Street 2:BUILDING D, SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-7048
Mailing Address - Country:US
Mailing Address - Phone:424-298-2725
Mailing Address - Fax:
Practice Address - Street 1:12777 W JEFFERSON BLVD
Practice Address - Street 2:BUILDING D, SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7048
Practice Address - Country:US
Practice Address - Phone:424-298-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28903103TC2200X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent