Active NPI
Robert Wilbut Lauridsen, PH.D.
- Psychologist
- Los Gatos, CA
National Provider Identifier
1134496896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 5763
- Practice address
- 455 Los Gatos Blvd
#202
Los Gatos, CA 95032-5523 - Phone
- (408) 356-2141
- NPI assigned
- Nov 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 5763 | CA | Primary |
Addresses
Primary practice location
455 Los Gatos Blvd
#202
Los Gatos, CA 95032-5523
Mailing address
19450 Redberry Dr
Los Gatos, CA 95030-2928
Phone (408) 398-4006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 5763 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1134496896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19450 REDBERRY DR",
"city": "LOS GATOS",
"state": "CA",
"postal_code": "950302928",
"telephone_number": "408-398-4006",
"fax_number": "408-356-2143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 LOS GATOS BLVD",
"address_2": "#202",
"city": "LOS GATOS",
"state": "CA",
"postal_code": "950325523",
"telephone_number": "408-356-2141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAURIDSEN",
"first_name": "ROBERT",
"middle_name": "WILBUT",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-23",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 5763",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Gatos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.