Provider Demographics
NPI:1003878992
Name:BURNS, LAURIE P (LCSW-R,GCP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:P
Last Name:BURNS
Suffix:
Gender:F
Credentials:LCSW-R,GCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SEMINOLE WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1317
Mailing Address - Country:US
Mailing Address - Phone:585-734-6826
Mailing Address - Fax:585-922-2646
Practice Address - Street 1:496 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1608
Practice Address - Country:US
Practice Address - Phone:585-734-6826
Practice Address - Fax:585-922-2646
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO52512-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7217673OtherATENA
NY137093FKOtherPREFERRED CARE
NY7217673OtherATENA