Provider Demographics
NPI:1508582206
Name:HANNIFAN, LAURA (LPC)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:HANNIFAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 WESTERLY DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1069
Mailing Address - Country:US
Mailing Address - Phone:215-460-2025
Mailing Address - Fax:
Practice Address - Street 1:2026 POLO RUN DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7261
Practice Address - Country:US
Practice Address - Phone:215-460-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00840200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional