Provider Demographics
NPI:1518005628
Name:TABAK, LAURA (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TABAK
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 1:844 CALIFORNIA ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-2315
Mailing Address - Country:US
Mailing Address - Phone:415-787-0080
Mailing Address - Fax:
Practice Address - Street 1:844 CALIFORNIA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-2315
Practice Address - Country:US
Practice Address - Phone:415-787-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25205103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical