Provider Demographics
NPI:1619211315
Name:MCFETRIDGE, LAURA ALENE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ALENE
Last Name:MCFETRIDGE
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 1:2840 W DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-4627
Mailing Address - Country:US
Mailing Address - Phone:215-739-2075
Mailing Address - Fax:215-203-3078
Practice Address - Street 1:100 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-4039
Practice Address - Country:US
Practice Address - Phone:215-203-3037
Practice Address - Fax:215-203-3078
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0162651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical