Provider Demographics
NPI:1538208699
Name:STRAWGATE KANEFSKY, LAURIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:STRAWGATE KANEFSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 ENGLE ST
Mailing Address - Street 2:BUILDING # 5
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 ENGLE ST
Practice Address - Street 2:BUILDING # 5
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2535
Practice Address - Country:US
Practice Address - Phone:201-871-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC016461041C0700X
NYPR020021-11041C0700X
NJFI01315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR020021-1OtherNYSTATE LICENSE
NJSC01646OtherLCSW- SOCIAL WORKER
NJFI01315OtherMARRIAGE AND FAMILY COUNS
NJFI01315OtherMARRIAGE AND FAMILY COUNS