Provider Demographics
NPI:1710040852
Name:GREENWOOD, LAURA TAYLOR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:TAYLOR
Last Name:GREENWOOD
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 1:3610 N. 44TH STREET,
Mailing Address - Street 2:# 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-218-6901
Mailing Address - Fax:602-218-6901
Practice Address - Street 1:3610 N. 44TH STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-218-6901
Practice Address - Fax:602-218-6901
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ116761041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical