Provider Demographics
NPI:1770115776
Name:TAORMINA, LAURA MICHELLE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:TAORMINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GUILDER PL
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2224
Mailing Address - Country:US
Mailing Address - Phone:518-928-7349
Mailing Address - Fax:
Practice Address - Street 1:634 PLANK RD STE 206
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4881
Practice Address - Country:US
Practice Address - Phone:518-456-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health