Provider Demographics
NPI:1295848547
Name:AUSSANT, LAURA (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AUSSANT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 1/2 KENT ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2305
Mailing Address - Country:US
Mailing Address - Phone:978-210-6402
Mailing Address - Fax:
Practice Address - Street 1:89 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-5706
Practice Address - Country:US
Practice Address - Phone:978-210-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1108251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07954OtherBLUE CROSS
MAP22623Medicare ID - Type Unspecified