Provider Demographics
NPI:1477643500
Name:WASHBURN, LAURA SCHREIBER (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SCHREIBER
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 WOODLOT RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3452
Mailing Address - Country:US
Mailing Address - Phone:413-253-5321
Mailing Address - Fax:
Practice Address - Street 1:433 WEST ST
Practice Address - Street 2:STE 6
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2936
Practice Address - Country:US
Practice Address - Phone:413-230-3686
Practice Address - Fax:815-550-2373
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1041CO700XOtherTAXONOMY CODE