Provider Demographics
NPI:1699008540
Name:WERONSKI, LAURA QUAGLINO (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:QUAGLINO
Last Name:WERONSKI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:QUAGLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 15035
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-5035
Mailing Address - Country:US
Mailing Address - Phone:805-419-5933
Mailing Address - Fax:
Practice Address - Street 1:2180 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4513
Practice Address - Country:US
Practice Address - Phone:805-419-5933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist