Provider Demographics
NPI:1598882342
Name:FREY, LAURENCE STEVEN (MA)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:STEVEN
Last Name:FREY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4244
Mailing Address - Country:US
Mailing Address - Phone:978-263-4771
Mailing Address - Fax:
Practice Address - Street 1:5 EDGELL RD
Practice Address - Street 2:GATEWAY COUNSELING SERVICES SUITE 24
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4874
Practice Address - Country:US
Practice Address - Phone:508-308-4538
Practice Address - Fax:508-879-1515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1279101YM0800X
MA399988103TS0200X
MA471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0060OtherBCBS NUMBER