Provider Demographics
NPI:1700238011
Name:KOVENS, LAURIE REBECCA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:REBECCA
Last Name:KOVENS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1200
Mailing Address - Country:US
Mailing Address - Phone:267-872-1053
Mailing Address - Fax:
Practice Address - Street 1:1403 TYLER CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1200
Practice Address - Country:US
Practice Address - Phone:267-872-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0101441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical