Provider Demographics
NPI:1477004794
Name:PESKIN, LAWRENCE (PSYD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:PESKIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10114 EMPYREAN WAY
Mailing Address - Street 2:APT. 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-3830
Mailing Address - Country:US
Mailing Address - Phone:440-281-7271
Mailing Address - Fax:
Practice Address - Street 1:10114 EMPYREAN WAY
Practice Address - Street 2:APT. 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-3830
Practice Address - Country:US
Practice Address - Phone:440-281-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical