Provider Demographics
NPI:1417964636
Name:HARKNESS, LAURIE L (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:L
Last Name:HARKNESS
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3784
Mailing Address - Country:US
Mailing Address - Phone:203-389-9686
Mailing Address - Fax:203-931-4068
Practice Address - Street 1:251 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3784
Practice Address - Country:US
Practice Address - Phone:203-389-9686
Practice Address - Fax:203-931-4068
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0005691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140000569CT01Medicare UPIN