Provider Demographics
NPI:1639751274
Name:HACKIMER, LAURA ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:HACKIMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 WHITTIER AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1203
Mailing Address - Country:US
Mailing Address - Phone:516-581-5778
Mailing Address - Fax:
Practice Address - Street 1:7022 RIDGE BLVD APT E7
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1220
Practice Address - Country:US
Practice Address - Phone:516-581-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023091103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist