Provider Demographics
NPI:1093082240
Name:BUELVAS-KRITAS, LAURIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BUELVAS-KRITAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:BUELVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N VILLAGE AVE
Mailing Address - Street 2:APT. 27
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3767
Mailing Address - Country:US
Mailing Address - Phone:516-761-6542
Mailing Address - Fax:
Practice Address - Street 1:100 N VILLAGE AVE
Practice Address - Street 2:APT. 27
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3767
Practice Address - Country:US
Practice Address - Phone:516-761-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057531-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker