Provider Demographics
NPI:1811152994
Name:DYE, LARA (PHD)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:DYE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LARA
Other - Middle Name:
Other - Last Name:CROWDER-DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1220 UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4262
Mailing Address - Country:US
Mailing Address - Phone:650-321-0119
Mailing Address - Fax:650-854-4743
Practice Address - Street 1:1220 UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4262
Practice Address - Country:US
Practice Address - Phone:650-321-0119
Practice Address - Fax:650-854-4743
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17434103T00000X
TX36382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist