Provider Demographics
NPI:1902922628
Name:WORDEN, LAUREEN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREEN
Middle Name:
Last Name:WORDEN
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:PO BOX 6653
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90264-6653
Mailing Address - Country:US
Mailing Address - Phone:310-924-1423
Mailing Address - Fax:
Practice Address - Street 1:6216 TAPIA DR APT B
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3151
Practice Address - Country:US
Practice Address - Phone:310-924-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19614103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist