Provider Demographics
NPI:1558626747
Name:LEFKOWITZ, LAURIE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:LEFKOWITZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91376-0391
Mailing Address - Country:US
Mailing Address - Phone:805-253-3526
Mailing Address - Fax:
Practice Address - Street 1:28240 AGOURA RD STE 301
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2489
Practice Address - Country:US
Practice Address - Phone:805-253-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 16413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist