Provider Demographics
NPI:1508868589
Name:SCHWERIN, LAURA BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BETH
Last Name:SCHWERIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 PACIFIC HWY UNIT 1401
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8418
Mailing Address - Country:US
Mailing Address - Phone:503-501-7995
Mailing Address - Fax:503-482-6241
Practice Address - Street 1:1199 PACIFIC HWY UNIT 1401
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8418
Practice Address - Country:US
Practice Address - Phone:503-501-7995
Practice Address - Fax:503-482-6241
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21854103T00000X, 103TC0700X
OR1285103TC0700X
CO0005631103TC0700X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287351Medicaid
OR287351Medicaid
OR105034Medicare ID - Type Unspecified