Provider Demographics
NPI:1710901707
Name:BINDER, LAURENCE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:M
Last Name:BINDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW GRIFFITH DRIVE
Mailing Address - Street 2:STE 244
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005
Mailing Address - Country:US
Mailing Address - Phone:503-626-5246
Mailing Address - Fax:503-626-1686
Practice Address - Street 1:4900 SW GRIFFITH DR
Practice Address - Street 2:STE 244
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-5607
Practice Address - Country:US
Practice Address - Phone:503-626-5246
Practice Address - Fax:503-626-1686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0420103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279570Medicaid
OR279570Medicaid
ORR57890Medicare UPIN
OR134281Medicare ID - Type UnspecifiedFOR PRIVATE PRACTICE ONLY