Provider Demographics
NPI:1639748833
Name:PLACE, LAURA MARGARET
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARGARET
Last Name:PLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 WISCONSIN AVE # 1070
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6105
Mailing Address - Country:US
Mailing Address - Phone:443-645-8232
Mailing Address - Fax:
Practice Address - Street 1:53 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1213
Practice Address - Country:US
Practice Address - Phone:443-645-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical