Provider Demographics
NPI:1083233514
Name:VANWORT-MENG, LAURA JEAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:VANWORT-MENG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:VANWORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 MAIN ST APT 422
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5142
Mailing Address - Country:US
Mailing Address - Phone:845-300-7586
Mailing Address - Fax:
Practice Address - Street 1:89 ACCESS RD STE 24
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5233
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA11370103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health