Provider Demographics
NPI:1356411128
Name:KING, LAUREL L (LCSW-R)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ELLINWOOD CT
Mailing Address - Street 2:ALAN P SMITH LCSW, PLLC
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1115
Mailing Address - Country:US
Mailing Address - Phone:315-724-3262
Mailing Address - Fax:315-724-3262
Practice Address - Street 1:3 ELLINWOOD COURT
Practice Address - Street 2:ALAN P SMITH LCSW, PLLC
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-724-3262
Practice Address - Fax:315-724-3262
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0527081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA0382Medicare ID - Type Unspecified
P38227Medicare UPIN