Provider Demographics
NPI:1861768772
Name:DESANTIS, LAURA (LPC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 S PARK ST STE 30
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-3336
Mailing Address - Country:US
Mailing Address - Phone:617-594-1327
Mailing Address - Fax:
Practice Address - Street 1:90 S PARK ST STE 30
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-3336
Practice Address - Country:US
Practice Address - Phone:617-594-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional