Provider Demographics
NPI:1891835401
Name:CALVIN HARRAH, PH.D.& MARLENE LAPING, PH.D. A PROFESSIONAL ORGANIZATIO
Entity Type:Organization
Organization Name:CALVIN HARRAH, PH.D.& MARLENE LAPING, PH.D. A PROFESSIONAL ORGANIZATIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-493-7452
Mailing Address - Street 1:28462 VIA MONDANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6331
Mailing Address - Country:US
Mailing Address - Phone:949-493-7452
Mailing Address - Fax:949-493-3885
Practice Address - Street 1:28462 VIA MONDANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6331
Practice Address - Country:US
Practice Address - Phone:949-493-7452
Practice Address - Fax:949-493-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11780103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15718Medicare PIN