Healthcare Provider Details

I. General information

NPI: 1609121201
Provider Name (Legal Business Name): LYRE CARUZ FRIBOURG PH.D, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12522 MOORPARK ST # 107
STUDIO CITY CA
91604-1355
US

IV. Provider business mailing address

12522 MOORPARK ST # 107
STUDIO CITY CA
91604-1355
US

V. Phone/Fax

Practice location:
  • Phone: 818-666-9434
  • Fax:
Mailing address:
  • Phone: 818-666-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5676
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number28857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: