Provider Demographics
NPI:1609254697
Name:DEVANEY, LAURA (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DEVANEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1439
Mailing Address - Country:US
Mailing Address - Phone:732-431-2155
Mailing Address - Fax:
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746
Practice Address - Country:US
Practice Address - Phone:732-431-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000187171100000X
NJ25MZ00108100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist