Provider Demographics
NPI:1932313905
Name:LAWTON, FLORICE ANGELA (PHD)
Entity Type:Individual
Prefix:
First Name:FLORICE
Middle Name:ANGELA
Last Name:LAWTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:REESE
Other - Middle Name:ANGELA
Other - Last Name:LAWTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:116 N MARYLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4263
Mailing Address - Country:US
Mailing Address - Phone:818-500-9636
Mailing Address - Fax:
Practice Address - Street 1:116 N MARYLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4263
Practice Address - Country:US
Practice Address - Phone:818-500-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP10651Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST