Provider Demographics
NPI:1750390290
Name:CARR-BRODIE, LAURI J (MFT)
Entity type:Individual
Prefix:MS
First Name:LAURI
Middle Name:J
Last Name:CARR-BRODIE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25129 THE OLD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-2244
Mailing Address - Country:US
Mailing Address - Phone:661-288-2960
Mailing Address - Fax:661-288-2960
Practice Address - Street 1:25129 THE OLD RD
Practice Address - Street 2:SUITE 202
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-2244
Practice Address - Country:US
Practice Address - Phone:661-288-2960
Practice Address - Fax:661-288-2960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31044106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist