Provider Demographics
NPI:1508185356
Name:ALCOCK, LAURA HELEN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:HELEN
Last Name:ALCOCK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:HELEN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:415 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1230
Mailing Address - Country:US
Mailing Address - Phone:812-423-7791
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:315 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-1723
Practice Address - Country:US
Practice Address - Phone:812-897-4776
Practice Address - Fax:812-422-7558
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33003624A104100000X
IN34007256A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN839090014Medicare PIN