Provider Demographics
NPI:1437152592
Name:KLUSMAN, LAWRENCE EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:KLUSMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 N OAK HILLS PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2859
Mailing Address - Country:US
Mailing Address - Phone:225-763-6300
Mailing Address - Fax:225-763-9358
Practice Address - Street 1:10630 N OAK HILLS PKWY
Practice Address - Street 2:STE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2859
Practice Address - Country:US
Practice Address - Phone:225-763-6300
Practice Address - Fax:225-763-9358
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA776MP103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X272Medicare ID - Type Unspecified