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General NPI Number Information
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NPI Number | 1497843437
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Entity Type | Individual
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Provider Name | ROBERT LAURENTZ PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 207 E COURT ST
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City | ITHACA
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State | NY
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Zip | 14850-4203
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Country | US
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Telephone | 607-339-1757
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Fax |
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Provider Business Mailing Address
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Address Line | 9 YARDLEY GRN
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City | ITHACA
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State | NY
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Zip | 14850-1260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 011909
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5008
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1835
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 71004446
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License Number State | IL
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