Provider Demographics
NPI:1114203411
Name:HOBART-DEMAGALL, LAUREL JOAN
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:JOAN
Last Name:HOBART-DEMAGALL
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:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01259-0343
Mailing Address - Country:US
Mailing Address - Phone:413-229-2644
Mailing Address - Fax:
Practice Address - Street 1:53 EAGLE ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5376
Practice Address - Country:US
Practice Address - Phone:413-236-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health