Provider Demographics
NPI:1235632357
Name:DISPENZERE, LAURA ANN (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:DISPENZERE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ANDERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1167
Mailing Address - Country:US
Mailing Address - Phone:201-396-0391
Mailing Address - Fax:
Practice Address - Street 1:8 ROBIN HOOD WAY
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5428
Practice Address - Country:US
Practice Address - Phone:973-368-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00407800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health