Provider Demographics
NPI:1609078401
Name:DECOSMO, LAURA (LSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:DECOSMO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SHOEMAKER ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3024
Mailing Address - Country:US
Mailing Address - Phone:570-331-7238
Mailing Address - Fax:
Practice Address - Street 1:130 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3113
Practice Address - Country:US
Practice Address - Phone:570-735-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW011837L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker