Provider Demographics
NPI:1578670048
Name:URE, LAURIE A (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:URE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1171
Mailing Address - Country:US
Mailing Address - Phone:978-283-6733
Mailing Address - Fax:
Practice Address - Street 1:11 HICKORY ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1171
Practice Address - Country:US
Practice Address - Phone:978-283-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10222661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891502OtherMBHP
MA012461OtherHARVARD PILGRIM HEALTH CA
MA390908OtherMAGELLAN BEHAVIORAL HEALT
MA1857746Medicaid
MAP07017OtherBLUE CROSS BLUE SHIELD
MA1857746Medicaid