Provider Demographics
NPI:1437209657
Name:LANDRY, LAURIE RIDGE (LMFT LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:RIDGE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LMFT LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2295 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:S GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073
Mailing Address - Country:US
Mailing Address - Phone:860-295-1366
Mailing Address - Fax:860-295-1366
Practice Address - Street 1:1177 SILAS DEANE HWY STE 4
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4332
Practice Address - Country:US
Practice Address - Phone:860-841-8563
Practice Address - Fax:860-295-1366
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000993101YM0800X
CT001062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health