Provider Demographics
NPI:1235691304
Name:LAURIE ZELAS PRIVATE PRACTICE LLC
Entity Type:Organization
Organization Name:LAURIE ZELAS PRIVATE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZELAS
Authorized Official - Suffix:
Authorized Official - Credentials:PMH CNS-BC
Authorized Official - Phone:508-653-0391
Mailing Address - Street 1:2 SUMMER ST STE 16
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4529
Mailing Address - Country:US
Mailing Address - Phone:508-653-0391
Mailing Address - Fax:508-653-0629
Practice Address - Street 1:2 SUMMER ST STE 16
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4529
Practice Address - Country:US
Practice Address - Phone:508-653-0391
Practice Address - Fax:508-653-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty