Provider Demographics
NPI:1629120803
Name:LIEFLAND, LAUREN E (PHD)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:E
Last Name:LIEFLAND
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 1:4081 STEPHENS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-785-5949
Mailing Address - Fax:619-785-5944
Practice Address - Street 1:2345 E 8TH ST
Practice Address - Street 2:STE 212
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2800
Practice Address - Country:US
Practice Address - Phone:619-585-4651
Practice Address - Fax:619-585-4692
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14785103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP14785AMedicare ID - Type Unspecified