Healthcare Provider Details

I. General information

NPI: 1881701704
Provider Name (Legal Business Name): LAURIE N SABRA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SHERIDAN ST SUITE 400
HOLLYWOOD FL
33021-3409
US

IV. Provider business mailing address

4600 SHERIDAN ST SUITE 400
HOLLYWOOD FL
33021-3409
US

V. Phone/Fax

Practice location:
  • Phone: 954-989-3600
  • Fax: 954-894-1884
Mailing address:
  • Phone: 954-989-3600
  • Fax: 954-894-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0004261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: