Provider Demographics
NPI:1902892300
Name:HOHNECKER, LAURA C (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:C
Last Name:HOHNECKER
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 1:4300 N UNIVERSITY DR
Mailing Address - Street 2:SUITE C100
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6249
Mailing Address - Country:US
Mailing Address - Phone:954-742-7449
Mailing Address - Fax:954-742-7169
Practice Address - Street 1:4300 N UNIVERSITY DR
Practice Address - Street 2:SUITE C100
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6249
Practice Address - Country:US
Practice Address - Phone:954-742-7449
Practice Address - Fax:954-742-7169
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
FLPY0005346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650595442 0005OtherCIGNA HEALTHCARE
FL59817BMedicare ID - Type UnspecifiedMEDICARE ID