MEDICARE: DR. LAUREN STUTMAN, PSYCHOLOGIST, APC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	PSY26768	CA

General Provider Information

NPI Number	:	1518484799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LAUREN STUTMAN, PSYCHOLOGIST, APC

Provider Business Mailing Address
First Line	:	10323 SANTA MONICA BLVD STE 111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5056
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10323 SANTA MONICA BLVD STE 111
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5056
Country	:	US
Telephone Number	:	917-971-4825
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAUREN BROOKE STUTMAN
Credential	:	PSY.D
Telephone Number	:	917-971-4825

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	06/20/2018

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