Provider Demographics
NPI:1205271483
Name:RAPPAPORT, LAURY (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURY
Middle Name:
Last Name:RAPPAPORT
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 1:1515 RIEBLI RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1036
Mailing Address - Country:US
Mailing Address - Phone:707-569-6264
Mailing Address - Fax:
Practice Address - Street 1:1350 S ELISEO DR
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2011
Practice Address - Country:US
Practice Address - Phone:415-461-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51052106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist