Provider Demographics
NPI:1275749327
Name:LAINE, GRETE MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:GRETE
Middle Name:MARIE
Last Name:LAINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WELWYN RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-2413
Mailing Address - Country:US
Mailing Address - Phone:203-637-2134
Mailing Address - Fax:203-637-1501
Practice Address - Street 1:36 WELWYN RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-2413
Practice Address - Country:US
Practice Address - Phone:203-637-2134
Practice Address - Fax:203-637-1501
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPO21595OtherREGISTRATION NUMBER NAAP