Provider Demographics
NPI:1467724542
Name:HANSEN, LAURA MCCRARY (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MCCRARY
Last Name:HANSEN
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 1:158 C AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1420
Mailing Address - Country:US
Mailing Address - Phone:619-435-5400
Mailing Address - Fax:
Practice Address - Street 1:158 C AVENUE
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1420
Practice Address - Country:US
Practice Address - Phone:619-435-5400
Practice Address - Fax:619-435-5401
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical