Provider Demographics
NPI:1730244575
Name:SCHAEFER, GREGORY LAWRENCE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LAWRENCE
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3377
Mailing Address - Country:US
Mailing Address - Phone:310-949-9256
Mailing Address - Fax:
Practice Address - Street 1:1554 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3377
Practice Address - Country:US
Practice Address - Phone:310-949-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20972103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist