Provider Demographics
NPI:1679180889
Name:SPATARO, LAURIE A (LMHC, LADC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:SPATARO
Suffix:
Gender:F
Credentials:LMHC, LADC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:855 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8218
Mailing Address - Country:US
Mailing Address - Phone:561-713-8511
Mailing Address - Fax:
Practice Address - Street 1:855 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8218
Practice Address - Country:US
Practice Address - Phone:561-713-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7124101YA0400X, 101Y00000X
FL20966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health