Provider Demographics
NPI:1528404936
Name:BELANGER, LAURIE MCKEIGHAN (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:MCKEIGHAN
Last Name:BELANGER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 TRANSIT RD
Mailing Address - Street 2:EAST AMHERST PSYCHOLOGY GROUP LLP
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1311
Mailing Address - Country:US
Mailing Address - Phone:716-906-9625
Mailing Address - Fax:716-636-4501
Practice Address - Street 1:9750 TRANSIT RD
Practice Address - Street 2:EAST AMHERST PSYCHOLOGY GROUP LLP
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1311
Practice Address - Country:US
Practice Address - Phone:716-906-9625
Practice Address - Fax:716-636-4501
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076893-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400354288Medicare PIN