Provider Demographics
NPI:1568811305
Name:TRAGEN-BOYKOFF, LAURIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:TRAGEN-BOYKOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 PARK COLONY CT
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3635
Mailing Address - Country:US
Mailing Address - Phone:818-917-4878
Mailing Address - Fax:
Practice Address - Street 1:26540 AGOURA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1914
Practice Address - Country:US
Practice Address - Phone:818-917-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS19965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional