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General NPI Number Information
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NPI Number | 1558708834
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Entity Type | Individual
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Provider Name | CRYSTAL LAYNE QUARRY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 02/24/2019
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Provider Practice Location Address
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Address Line | 225 AVENUE I STE 204
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5608
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Country | US
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Telephone | 424-903-6520
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Fax |
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Provider Business Mailing Address
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Address Line | 2029 AVENIDA FELICIANO
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-1008
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Country | US
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Telephone | 424-903-6520
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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 | PSB94022808
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License Number State | CA
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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 | PSY29982
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License Number State | CA
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