Provider Demographics
NPI:1225454630
Name:MUSHOLT, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MUSHOLT
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 1:243 SUYDAM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-3101
Mailing Address - Country:US
Mailing Address - Phone:347-627-2288
Mailing Address - Fax:347-881-1616
Practice Address - Street 1:243 SUYDAM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3101
Practice Address - Country:US
Practice Address - Phone:347-627-2288
Practice Address - Fax:347-881-1616
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker