Healthcare Provider Details

I. General information

NPI: 1902892300
Provider Name (Legal Business Name): LAURA C. HOHNECKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/24/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

4300 N UNIVERSITY DR SUITE C100
SUNRISE FL
33351-6249
US

IV. Provider business mailing address

4300 N UNIVERSITY DR SUITE C100
SUNRISE FL
33351-6249
US

V. Phone/Fax

Practice location:
  • Phone: 954-742-7449
  • Fax: 954-742-7169
Mailing address:
  • Phone: 954-742-7449
  • Fax: 954-742-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0005346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: