Provider Demographics
NPI:1609904424
Name:RAIO, LAURANCE ANNE (MS PSYCHOLOGY)
Entity Type:Individual
Prefix:MS
First Name:LAURANCE
Middle Name:ANNE
Last Name:RAIO
Suffix:
Gender:F
Credentials:MS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 FLINTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2805
Mailing Address - Country:US
Mailing Address - Phone:631-472-2767
Mailing Address - Fax:
Practice Address - Street 1:31 FLINTRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2805
Practice Address - Country:US
Practice Address - Phone:631-472-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1678038103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist