Provider Demographics
NPI:1629175179
Name:WAITE, LAURIE M (MSW, LSW)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:M
Last Name:WAITE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1238
Mailing Address - Country:US
Mailing Address - Phone:814-207-8827
Mailing Address - Fax:
Practice Address - Street 1:JAMES E. VANZANDT VA MEDICAL CENTER
Practice Address - Street 2:2907 PLEASANT VALLEY BLVD.
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker