Provider Demographics
NPI:1659647626
Name:MARR, LAURA L (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:MARR
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 1:42 SENNE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1417
Mailing Address - Country:US
Mailing Address - Phone:631-261-5200
Mailing Address - Fax:
Practice Address - Street 1:103 FORT SALONGA RD STE 16
Practice Address - Street 2:
Practice Address - City:FORT SALONGA
Practice Address - State:NY
Practice Address - Zip Code:11768-1454
Practice Address - Country:US
Practice Address - Phone:631-261-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079389-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical