Provider Demographics
NPI:1548508245
Name:CHEZAN, LAURA CLAUDIA (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CLAUDIA
Last Name:CHEZAN
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 1:2505 BLOSSOM ST APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2358
Mailing Address - Country:US
Mailing Address - Phone:843-601-3204
Mailing Address - Fax:
Practice Address - Street 1:2505 BLOSSOM ST APT D
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2358
Practice Address - Country:US
Practice Address - Phone:843-601-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7499103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst