Provider Demographics
NPI:1255473799
Name:JUNE, LAURA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:JUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 W NORTHERN PKWY APT 105A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1447
Mailing Address - Country:US
Mailing Address - Phone:410-235-7899
Mailing Address - Fax:410-433-2288
Practice Address - Street 1:1190 W NORTHERN PKWY APT 105A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1447
Practice Address - Country:US
Practice Address - Phone:410-235-7899
Practice Address - Fax:410-433-2288
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD151391Medicare PIN