Provider Demographics
NPI:1578686978
Name:CLOSE, LAURIE SUTHERLAND (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:SUTHERLAND
Last Name:CLOSE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 COLE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9724
Mailing Address - Country:US
Mailing Address - Phone:315-559-7576
Mailing Address - Fax:
Practice Address - Street 1:4570 COLE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-9724
Practice Address - Country:US
Practice Address - Phone:315-559-7576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069589-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical