Provider Demographics
NPI:1710010954
Name:PAGE, LAURA (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GROZIER RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2124
Mailing Address - Country:US
Mailing Address - Phone:617-710-5786
Mailing Address - Fax:
Practice Address - Street 1:86 BAKER AVENUE EXT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2132
Practice Address - Country:US
Practice Address - Phone:978-369-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10312111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA226968OtherTRICARE
MAP10320OtherBCBS
MAP10320OtherBCBS