Provider Demographics
NPI:1649562562
Name:BOOTH, LAURA E (BSW, CAP, ICRC, CET)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:E
Last Name:BOOTH
Suffix:
Gender:F
Credentials:BSW, CAP, ICRC, CET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 NE 20TH ST
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2146
Mailing Address - Country:US
Mailing Address - Phone:954-494-4281
Mailing Address - Fax:
Practice Address - Street 1:5131 NE 19TH TER
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5635
Practice Address - Country:US
Practice Address - Phone:954-494-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)