Provider Demographics
NPI:1578447314
Name:LAIRD, BOBBI D (ED S)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:D
Last Name:LAIRD
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BETHANY RD APT 205
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4260
Mailing Address - Country:US
Mailing Address - Phone:978-855-0156
Mailing Address - Fax:
Practice Address - Street 1:230 BETHANY RD APT 205
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4260
Practice Address - Country:US
Practice Address - Phone:978-855-0156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250075383103TS0200X
MA388088103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool