Provider Demographics
NPI:1457449266
Name:MCROBERTS, LAURA ARLEEN (PSYD)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ARLEEN
Last Name:MCROBERTS
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 1:11303 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6003
Mailing Address - Country:US
Mailing Address - Phone:310-482-6660
Mailing Address - Fax:310-313-0973
Practice Address - Street 1:11303 W. WASHINGTON BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1605
Practice Address - Country:US
Practice Address - Phone:310-482-6660
Practice Address - Fax:310-313-0973
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225400000XMedicare ID - Type UnspecifiedUNLICENSED MENTAL HEALTH