Provider Demographics
NPI:1558851501
Name:HAUGHTON, LAURA (LAURA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HAUGHTON
Suffix:
Gender:F
Credentials:LAURA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:NEGRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2224 JESSICA LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6447
Mailing Address - Country:US
Mailing Address - Phone:407-459-3499
Mailing Address - Fax:
Practice Address - Street 1:2224 JESSICA LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-6447
Practice Address - Country:US
Practice Address - Phone:407-459-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104100000XMedicaid