Provider Demographics
NPI:1093897035
Name:LAURIA, JENNIFER RANEE (PSYSP, LLP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RANEE
Last Name:LAURIA
Suffix:
Gender:F
Credentials:PSYSP, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2253
Mailing Address - Country:US
Mailing Address - Phone:734-451-3440
Mailing Address - Fax:734-451-8720
Practice Address - Street 1:1308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2253
Practice Address - Country:US
Practice Address - Phone:734-451-3440
Practice Address - Fax:734-451-8720
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012770103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist