Provider Demographics
NPI:1619105657
Name:LAURENDEAU, GAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:LAURENDEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1612
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85001-1612
Mailing Address - Country:US
Mailing Address - Phone:602-264-2114
Mailing Address - Fax:602-264-2114
Practice Address - Street 1:3030 N 14TH ST APT 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5632
Practice Address - Country:US
Practice Address - Phone:602-264-2114
Practice Address - Fax:602-264-2114
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 127661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical