Provider Demographics
NPI:1093906927
Name:EARLS, LAUREL IV
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:EARLS
Suffix:IV
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 1:35 MEDFORD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4242
Mailing Address - Country:US
Mailing Address - Phone:617-629-6792
Mailing Address - Fax:
Practice Address - Street 1:35 MEDFORD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4242
Practice Address - Country:US
Practice Address - Phone:617-629-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist