Provider Demographics
NPI:1275879769
Name:LUNA, LAURA KEATING
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KEATING
Last Name:LUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-5760
Mailing Address - Country:US
Mailing Address - Phone:860-885-6054
Mailing Address - Fax:860-885-6062
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5760
Practice Address - Country:US
Practice Address - Phone:860-885-6054
Practice Address - Fax:860-885-6062
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health