Provider Demographics
NPI:1659582278
Name:FRAUMAN, LAURENCE (MA MFCT)
Entity Type:Individual
Prefix:MR
First Name:LAURENCE
Middle Name:
Last Name:FRAUMAN
Suffix:
Gender:M
Credentials:MA MFCT
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 39A47
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039
Mailing Address - Country:US
Mailing Address - Phone:323-663-4479
Mailing Address - Fax:
Practice Address - Street 1:420 SOUTH BEVERLY DRIVE
Practice Address - Street 2:SUITE 100-4
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-277-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24907106H00000X
WALF00001677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist