Provider Demographics
NPI:1457321200
Name:KRAMER, LAURIE A (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:KRAMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ANDREW RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2542
Mailing Address - Country:US
Mailing Address - Phone:516-652-5313
Mailing Address - Fax:
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:STE 304
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2222
Practice Address - Country:US
Practice Address - Phone:516-652-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES65834Medicare UPIN
NYV79921Medicare ID - Type Unspecified