Provider Demographics
NPI:1518169531
Name:LASKY, BENJAMIN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:LASKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12160 MONTANA AVE
Mailing Address - Street 2:#8
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5271
Mailing Address - Country:US
Mailing Address - Phone:805-689-6352
Mailing Address - Fax:818-785-6358
Practice Address - Street 1:15216 VANOWEN ST
Practice Address - Street 2:#2C
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3601
Practice Address - Country:US
Practice Address - Phone:818-785-6377
Practice Address - Fax:818-785-6358
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist