Provider Demographics
NPI:1144754045
Name:VATENOS, LAURA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VATENOS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 MARTIN CT W
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2214
Mailing Address - Country:US
Mailing Address - Phone:410-991-0468
Mailing Address - Fax:
Practice Address - Street 1:791 MARTIN CT W
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2214
Practice Address - Country:US
Practice Address - Phone:410-991-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical