Healthcare Provider Details

I. General information

NPI: 1851445019
Provider Name (Legal Business Name): LAURIE NOEL RABENS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 W SHAW AVE
FRESNO CA
93711-3204
US

IV. Provider business mailing address

3443 W SHAW AVE
FRESNO CA
93711-3204
US

V. Phone/Fax

Practice location:
  • Phone: 559-271-1186
  • Fax: 559-271-8041
Mailing address:
  • Phone: 559-271-1186
  • Fax: 559-271-8041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: