Provider Demographics
NPI:1275803652
Name:BARRETTO, LAURA D
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:BARRETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:DENISE
Other - Last Name:POLASEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1623 MESA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2253
Mailing Address - Country:US
Mailing Address - Phone:512-496-6991
Mailing Address - Fax:
Practice Address - Street 1:1623 MESA VERDE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2253
Practice Address - Country:US
Practice Address - Phone:512-496-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional