Provider Demographics
NPI:1063826600
Name:MOGAVERO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MOGAVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1301
Mailing Address - Country:US
Mailing Address - Phone:800-778-5560
Mailing Address - Fax:
Practice Address - Street 1:102 PERIMETER RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1301
Practice Address - Country:US
Practice Address - Phone:800-778-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHBACB339352103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst