Provider Demographics
NPI:1558505040
Name:STANZIONE, LAURA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:STANZIONE
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 1:1201 BROAD ROCK BLVD
Mailing Address - Street 2:VA MCGUIRE
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23149-0002
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:804-675-5509
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0002
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-5509
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW4850OtherFL BOARD OF CLINICAL SOCIAL WORK,MARRIAGE AND FAMILY
VA0904008753OtherVIRGINIA BOARD OF LICENSED SOCIAL WORKERS