Provider Demographics
NPI:1700387057
Name:SGRO, LAURA FAE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:FAE
Last Name:SGRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S GLENOAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2787
Mailing Address - Country:US
Mailing Address - Phone:818-940-3386
Mailing Address - Fax:
Practice Address - Street 1:601 S GLENOAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2787
Practice Address - Country:US
Practice Address - Phone:818-940-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW86023104100000X
CALCSW1007051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker