Provider Demographics
NPI:1871638577
Name:TONDOW, LAURIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIANE
Middle Name:
Last Name:TONDOW
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 1:3560 J ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5445
Mailing Address - Country:US
Mailing Address - Phone:916-974-7960
Mailing Address - Fax:916-974-7960
Practice Address - Street 1:3560 J ST STE 6
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5445
Practice Address - Country:US
Practice Address - Phone:916-974-7960
Practice Address - Fax:916-974-7960
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11885103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist