Provider Demographics
NPI:1255402657
Name:BECKER, LAURENCE DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:DAVID
Last Name:BECKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5319 UNIVERSITY DR
Mailing Address - Street 2:PMB 226
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2965
Mailing Address - Country:US
Mailing Address - Phone:949-833-1268
Mailing Address - Fax:949-854-1843
Practice Address - Street 1:7 CORPORATE PARK
Practice Address - Street 2:SUITE 250
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5107
Practice Address - Country:US
Practice Address - Phone:949-833-1268
Practice Address - Fax:949-854-1843
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5491103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent