Provider Demographics
NPI:1114686144
Name:ARCHER, LAURIE ANN (LMSW, MS)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:ARCHER
Suffix:
Gender:F
Credentials:LMSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 5TH AVE APT 25H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3127
Mailing Address - Country:US
Mailing Address - Phone:212-722-1260
Mailing Address - Fax:
Practice Address - Street 1:1309 5TH AVE APT 25H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3127
Practice Address - Country:US
Practice Address - Phone:212-722-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063151104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061351OtherLICENSED MASTERS SOCIAL WORKER
NY063151OtherLICESNED MASTERS SOCIAL WORKER