Provider Demographics
NPI:1578639944
Name:OSTENDORF, LAURIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:OSTENDORF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CENTER ST
Mailing Address - Street 2:SUITE 429
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3031
Mailing Address - Country:US
Mailing Address - Phone:413-584-0114
Mailing Address - Fax:413-584-0447
Practice Address - Street 1:16 CENTER ST
Practice Address - Street 2:SUITE 429
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3031
Practice Address - Country:US
Practice Address - Phone:413-584-0114
Practice Address - Fax:413-584-0447
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51316Medicare ID - Type Unspecified