Provider Demographics
NPI:1689231623
Name:MARTORANO, LAURA (MA, LPC/MHSP, RPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MARTORANO
Suffix:
Gender:F
Credentials:MA, LPC/MHSP, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 BRISTOL HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3162
Mailing Address - Country:US
Mailing Address - Phone:234-328-1289
Mailing Address - Fax:
Practice Address - Street 1:4132 BRISTOL HWY STE 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3162
Practice Address - Country:US
Practice Address - Phone:423-328-1289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health