Provider Demographics
NPI:1780641241
Name:YABROFF, LAWRENCE JONAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JONAS
Last Name:YABROFF
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 1:2340 WARD ST
Mailing Address - Street 2:102
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1124
Mailing Address - Country:US
Mailing Address - Phone:510-649-0640
Mailing Address - Fax:510-549-2125
Practice Address - Street 1:2340 WARD ST
Practice Address - Street 2:102
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1124
Practice Address - Country:US
Practice Address - Phone:510-649-0640
Practice Address - Fax:510-549-2125
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY093710Medicaid
CA00PL93710Medicare ID - Type Unspecified
CAPSY093710Medicaid