Provider Demographics
NPI:1063447555
Name:KANTER, LAURA MYERS (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MYERS
Last Name:KANTER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GRAYSON RD
Mailing Address - Street 2:JEWISH FAMILY SERVICE OF TIDEWATER INC
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4345
Mailing Address - Country:US
Mailing Address - Phone:757-459-4640
Mailing Address - Fax:757-459-4643
Practice Address - Street 1:260 GRAYSON RD
Practice Address - Street 2:JEWISH FAMILY SERVICE OF TIDEWATER INC
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4345
Practice Address - Country:US
Practice Address - Phone:757-459-4640
Practice Address - Fax:757-459-4643
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040035001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA264225OtherBLUE CROSS
VA8914311Medicaid
VA005125J52Medicare ID - Type Unspecified
VA8914311Medicaid