Provider Demographics
NPI:1659998201
Name:DEWEY, LAURA MACK (MA, LADC, LCMHC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MACK
Last Name:DEWEY
Suffix:
Gender:F
Credentials:MA, LADC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0671
Mailing Address - Country:US
Mailing Address - Phone:802-595-3537
Mailing Address - Fax:
Practice Address - Street 1:85 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1537
Practice Address - Country:US
Practice Address - Phone:603-653-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0129414101YA0400X
VT068.0132901101YM0800X
NH2666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)