Provider Demographics
NPI:1184646150
Name:CORNELSEN, LAURA A (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:CORNELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:HERRMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:561 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1905
Mailing Address - Country:US
Mailing Address - Phone:215-720-6277
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 402B
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7710
Practice Address - Country:US
Practice Address - Phone:215-720-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical