Provider Demographics
NPI:1598217143
Name:GORELICK, LAURA (LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GORELICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2590
Mailing Address - Country:US
Mailing Address - Phone:908-233-3720
Mailing Address - Fax:908-389-5675
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-233-3720
Practice Address - Fax:908-389-5675
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00139100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional