Provider Demographics
NPI:1548464043
Name:HARRISON, LAURA MADLYN (LCADC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MADLYN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MAPLE AVE
Mailing Address - Street 2:PO BOX 812
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1731
Mailing Address - Country:US
Mailing Address - Phone:732-747-1035
Mailing Address - Fax:732-747-1069
Practice Address - Street 1:234 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1731
Practice Address - Country:US
Practice Address - Phone:732-747-1035
Practice Address - Fax:732-747-1069
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00126700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist