Provider Demographics
NPI:1649440645
Name:VINER, LAURA LYNN (PH D)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:VINER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PH D
Mailing Address - Street 1:1560 SHERMAN AVE., SUITE 400
Mailing Address - Street 2:YELLOWBRICK
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4803
Mailing Address - Country:US
Mailing Address - Phone:847-869-1500
Mailing Address - Fax:847-869-1515
Practice Address - Street 1:1560 SHERMAN AVE., SUITE 400
Practice Address - Street 2:YELLOWBRICK
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4803
Practice Address - Country:US
Practice Address - Phone:847-869-1500
Practice Address - Fax:847-869-1515
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004111103TC0700X
IL071.004111103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical