Provider Demographics
NPI:1649377110
Name:LYMAN, LAURA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:LYMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6016
Mailing Address - Country:US
Mailing Address - Phone:310-373-8343
Mailing Address - Fax:310-373-8513
Practice Address - Street 1:24050 MADISON ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6016
Practice Address - Country:US
Practice Address - Phone:310-373-8343
Practice Address - Fax:310-373-8513
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16669Medicare ID - Type Unspecified
CAP22175Medicare UPIN