Provider Demographics
NPI:1063641462
Name:LAURIE WAXLER CSW PC
Entity Type:Organization
Organization Name:LAURIE WAXLER CSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXLER
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:914-524-9646
Mailing Address - Street 1:34 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5010
Mailing Address - Country:US
Mailing Address - Phone:914-524-9646
Mailing Address - Fax:914-524-9646
Practice Address - Street 1:34 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5010
Practice Address - Country:US
Practice Address - Phone:914-524-9646
Practice Address - Fax:914-524-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017430251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health