Provider Demographics
NPI:1720203136
Name:FREY, LAURA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:FREY
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 1:41 SPINDLE RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6229
Mailing Address - Country:US
Mailing Address - Phone:516-735-6798
Mailing Address - Fax:
Practice Address - Street 1:ST. JOHN'S EPISCOPAL HOSPITAL, COMMUNITY MENTAL HEALTH
Practice Address - Street 2:521 BEACH 20TH STREET
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-8822
Practice Address - Fax:718-869-8829
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035763-11041C0700X
NY035763104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035763-1OtherLCSW
NY00035763Medicaid