MEDICARE: DR. LAURIE M. BOXER 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	103TC0700X	Clinical Psychologist	PSY13411	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770679375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE M. BOXER PH.D.

Provider Business Mailing Address
First Line	:	5150 YARMOUTH AVE.
Second Line	:	#112
City	:	ENCINO
State	:	CA
Zip	:	91316
Country	:	US
Telephone Number	:	818-757-1940
Fax Number	:	310-268-3821

Provider Business Practice Location Address
First Line	:	15720 VENTURA BLVD
Second Line	:	SUITE 600
City	:	ENCINO
State	:	CA
Zip	:	91436-2914
Country	:	US
Telephone Number	:	818-757-1940
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/24/2007

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