Provider Demographics
NPI:1477065886
Name:CROTTY, LAURA ANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:CROTTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01611-3157
Mailing Address - Country:US
Mailing Address - Phone:774-696-4502
Mailing Address - Fax:
Practice Address - Street 1:48 BROWN ST
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:MA
Practice Address - Zip Code:01611-3157
Practice Address - Country:US
Practice Address - Phone:774-696-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health