Provider Demographics
NPI:1215955695
Name:DAYTON, LAURENCE L (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:L
Last Name:DAYTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 ANDROMEDA LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2220
Mailing Address - Country:US
Mailing Address - Phone:954-431-1709
Mailing Address - Fax:954-389-0958
Practice Address - Street 1:1560 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2858
Practice Address - Country:US
Practice Address - Phone:954-431-1709
Practice Address - Fax:954-389-0958
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74353ZMedicare PIN
FLR04059Medicare UPIN