Healthcare Provider Details

I. General information

NPI: 1083699557
Provider Name (Legal Business Name): LAURA E. FORSYTH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CARMEN DR STE. 211
CAMARILLO CA
93010-3105
US

IV. Provider business mailing address

1601 CARMEN DR STE. 211
CAMARILLO CA
93010-3105
US

V. Phone/Fax

Practice location:
  • Phone: 805-795-2131
  • Fax: 805-322-2103
Mailing address:
  • Phone: 805-795-2131
  • Fax: 805-322-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 17938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: