Provider Demographics
NPI:1700859626
Name:KRAUSE, LAURESTA LYNNE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LAURESTA
Middle Name:LYNNE
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 DUCHESS LANE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639
Mailing Address - Country:US
Mailing Address - Phone:410-474-4650
Mailing Address - Fax:
Practice Address - Street 1:1304 DUCHESS LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639-2336
Practice Address - Country:US
Practice Address - Phone:410-474-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG1010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health