Provider Demographics
NPI:1427015791
Name:LACRITZ, LAURA HOPPENSTEIN (PHD ABPP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HOPPENSTEIN
Last Name:LACRITZ
Suffix:
Gender:F
Credentials:PHD ABPP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JANELLE
Other - Last Name:HOPPENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0624
Mailing Address - Fax:214-645-0078
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-648-4646
Practice Address - Fax:214-648-4660
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25366103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF58733Medicare UPIN
TXLA082358PMedicare ID - Type Unspecified