Provider Demographics
NPI:1962296129
Name:BABCOCK, LAURA (MA, EDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:
Credentials:MA, EDS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:510 G ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1259
Mailing Address - Country:US
Mailing Address - Phone:925-779-7500
Mailing Address - Fax:
Practice Address - Street 1:4700 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8486
Practice Address - Country:US
Practice Address - Phone:925-779-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240187874103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool