MEDICARE: NOAH LARACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	30134	CA

General Provider Information

NPI Number	:	1700362449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH LARACY

Provider Business Mailing Address
First Line	:	1810 S BEVERLY DRIVE
Second Line	:	SUITE 401
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1156
Country	:	US
Telephone Number	:	213-446-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 S BEVERLY DRIVE
Second Line	:	SUITE 401
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1156
Country	:	US
Telephone Number	:	213-446-3666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	07/16/2018

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Directions to “ NOAH LARACY ” Practice Location

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