Provider Demographics
NPI:1710051651
Name:SUGARMAN-WHITTIER, LAURIE E (MSW)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:E
Last Name:SUGARMAN-WHITTIER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 EDMANDS RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3075
Mailing Address - Country:US
Mailing Address - Phone:508-788-0124
Mailing Address - Fax:508-229-4469
Practice Address - Street 1:14 VERNON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4733
Practice Address - Country:US
Practice Address - Phone:508-788-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1040921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASUP03240OtherBLUE CROSS BLUE SHIELD
MASUP03240Medicare ID - Type Unspecified