Provider Demographics
NPI:1558088872
Name:ESPADA, LAURA ROSE
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ROSE
Last Name:ESPADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FRANKLIN AVE APT 425
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2183
Mailing Address - Country:US
Mailing Address - Phone:347-623-9021
Mailing Address - Fax:
Practice Address - Street 1:180 FRANKLIN AVE APT 425
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2183
Practice Address - Country:US
Practice Address - Phone:347-623-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool