Provider Demographics
NPI:1396777546
Name:HOWARD, LAWRENCE
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3192
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90408-3192
Mailing Address - Country:US
Mailing Address - Phone:310-710-2029
Mailing Address - Fax:
Practice Address - Street 1:12575 PRESTON WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-1823
Practice Address - Country:US
Practice Address - Phone:310-710-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY107950OtherLOS ANGELES COUNTY
CAPSY107950Medicaid
CACP10795Medicare PIN
CAPSY107950OtherLOS ANGELES COUNTY