Provider Demographics
NPI:1407995772
Name:VIALE, LAURA R (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:VIALE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FLOYD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4236
Mailing Address - Country:US
Mailing Address - Phone:781-330-9144
Mailing Address - Fax:
Practice Address - Street 1:697 WASHINGTON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1260
Practice Address - Country:US
Practice Address - Phone:781-330-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3714171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor