MEDICARE: DR. LAUREN STUTMAN PSY.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	2084P0800X	Psychiatry Physician	26768	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	26768	CA

General Provider Information

NPI Number	:	1801281365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN STUTMAN PSY.D

Provider Business Mailing Address
First Line	:	10323 SANTA MONICA BLVD
Second Line	:	SUITE 111
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6071
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10323 SANTA MONICA BLVD
Second Line	:	SUITE 111
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6071
Country	:	US
Telephone Number	:	917-971-4825
Fax Number	:

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

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	10/05/2015

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