Provider Demographics
NPI:1386771475
Name:LOBER, LAURIE (LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:LOBER
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LAKESHORE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1187
Mailing Address - Country:US
Mailing Address - Phone:510-763-7992
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:2100 LAKESHORE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1187
Practice Address - Country:US
Practice Address - Phone:510-763-7992
Practice Address - Fax:510-655-3379
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS104681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01574004Medicare UPIN
CAZZZ01369ZMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION N