MEDICARE: DR. LAUREN BROOKMAN-FRAZEE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSY 20300	CA

General Provider Information

NPI Number	:	1265661714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN BROOKMAN-FRAZEE PH.D.

Provider Business Mailing Address
First Line	:	3020 CHILDREN'S WAY (MC 5033)
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	858-966-7703
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 CHILDREN'S WAY (MC 5033)
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	858-966-7703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	07/06/2009

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