Provider Demographics
NPI:1477804458
Name:MAGNESS, LAURA MICHELLE SANDS (PSYD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE SANDS
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SYKES CREEK PKWY
Mailing Address - Street 2:UNIT 801
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 S SYKES CREEK PKWY
Practice Address - Street 2:UNIT 801
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3313
Practice Address - Country:US
Practice Address - Phone:608-609-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8597103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist