Provider Demographics
NPI:1881718583
Name:DUBIN, LAURIE ASTOR (PHD)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ASTOR
Last Name:DUBIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:ASTOR DUBIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10921 WILSHIRE BOULEVARD
Mailing Address - Street 2:SUITE 507
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-824-1063
Mailing Address - Fax:
Practice Address - Street 1:10921 WILSHIRE BOULEVARD
Practice Address - Street 2:SUITE 507
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:310-824-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical