Provider Demographics
NPI:1679548812
Name:STONE, LAURIE GALE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:GALE
Last Name:STONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 PEERLESS PL
Mailing Address - Street 2:APT. 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2845
Mailing Address - Country:US
Mailing Address - Phone:310-203-8732
Mailing Address - Fax:310-203-8732
Practice Address - Street 1:2566 OVERLAND AVE
Practice Address - Street 2:SUITE 500B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3366
Practice Address - Country:US
Practice Address - Phone:310-479-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical