Provider Demographics
NPI:1386846392
Name:ETRE, LAURA P (PSYD/CLINICAL PSYCHO)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:P
Last Name:ETRE
Suffix:
Gender:F
Credentials:PSYD/CLINICAL PSYCHO
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Mailing Address - Street 1:20 RESEARCH PARKWAY
Mailing Address - Street 2:STE C
Mailing Address - City:OLD SAYBROCK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4214
Mailing Address - Country:US
Mailing Address - Phone:800-370-3651
Mailing Address - Fax:860-510-0020
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:1ST FLOOR WELD BUILDING
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:800-370-3651
Practice Address - Fax:860-510-0020
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YA0400X
RIPS01112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)