Provider Demographics
NPI:1104963925
Name:RANSDELL, LAURA E (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:RANSDELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56244 PAPAGO TRL STE 5
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3285
Mailing Address - Country:US
Mailing Address - Phone:760-910-5017
Mailing Address - Fax:
Practice Address - Street 1:56244 PAPAGO TRL STE 5
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3285
Practice Address - Country:US
Practice Address - Phone:760-910-5017
Practice Address - Fax:760-418-5451
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 273671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP517AMedicare PIN