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NPI Code Detail

MEDICARE: DR. LAURA R. ADDISON PH.D, BCBA-D

MEDICARE: DR. LAURA R. ADDISON PH.D, BCBA-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
1103TC0700XClinical PsychologistPSY 22059CA
2103K00000XBehavior Analyst1-05-2114

General Provider Information

NPI Number : 1306171830
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA R. ADDISON PH.D, BCBA-D
Provider Business Mailing Address
First Line : 1000 PASEO CAMARILLO STE 235
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-0754
Country : US
Telephone Number : 805-383-5566
Fax Number : 888-659-0031
Provider Business Practice Location Address
First Line : 1000 PASEO CAMARILLO STE 235
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-0754
Country : US
Telephone Number : 805-383-5566
Fax Number : 888-659-0031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2009
Last Update Date : 08/12/2021

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