Provider Demographics
NPI:1003071044
Name:SHERIDAN, LAURA KATHARINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KATHARINE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:KATHARINE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:22 GREELEY ST STE 9D
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4460
Mailing Address - Country:US
Mailing Address - Phone:603-365-4989
Mailing Address - Fax:
Practice Address - Street 1:22 GREELEY ST STE 9D
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4460
Practice Address - Country:US
Practice Address - Phone:603-365-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10341103T00000X
MI6301014002103T00000X
NH1291103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3091335Medicaid