Provider Demographics
NPI:1376631382
Name:WIERS, LAUREL ANNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:ANNE
Last Name:WIERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:WATROUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339
Mailing Address - Country:US
Mailing Address - Phone:860-448-9755
Mailing Address - Fax:860-572-4986
Practice Address - Street 1:481 GOLD STAR HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-448-9755
Practice Address - Fax:860-572-4986
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist