Provider Demographics
NPI:1871667006
Name:REIFSNYDER, LAURIE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:REIFSNYDER
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 1:848 ROSANA PL
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5606
Mailing Address - Country:US
Mailing Address - Phone:805-929-6241
Mailing Address - Fax:805-929-6241
Practice Address - Street 1:848 ROSANA PL
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-5606
Practice Address - Country:US
Practice Address - Phone:805-929-6241
Practice Address - Fax:805-929-6241
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5886103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP5886Medicare ID - Type Unspecified