Provider Demographics
NPI:1952488025
Name:WEINSTOCK, LAURA H (PHD CLINICAL PSYCHOL)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:WEINSTOCK
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 CARONDELET AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3319
Mailing Address - Country:US
Mailing Address - Phone:314-727-7726
Mailing Address - Fax:314-727-7725
Practice Address - Street 1:7710 CARONDELET AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3319
Practice Address - Country:US
Practice Address - Phone:314-727-7726
Practice Address - Fax:314-727-7725
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002672103TC0700X
MO2010033643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical