Provider Demographics
NPI:1376805614
Name:HAUCK, LAURA JEAN (MA,ED)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:HAUCK
Suffix:
Gender:F
Credentials:MA,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 KENT ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5005
Mailing Address - Country:US
Mailing Address - Phone:516-586-3399
Mailing Address - Fax:
Practice Address - Street 1:135 KENT ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5005
Practice Address - Country:US
Practice Address - Phone:516-586-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist