Provider Demographics
NPI:1497388854
Name:LAUDEMAN, MAURISSA (LCSW)
Entity Type:Individual
Prefix:
First Name:MAURISSA
Middle Name:
Last Name:LAUDEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 GERMANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-9047
Mailing Address - Country:US
Mailing Address - Phone:570-985-3774
Mailing Address - Fax:
Practice Address - Street 1:223 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6201
Practice Address - Country:US
Practice Address - Phone:570-455-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical