Provider Demographics
NPI:1730461294
Name:PAUL, LAURY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURY
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E 85TH ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0440
Mailing Address - Country:US
Mailing Address - Phone:212-289-2245
Mailing Address - Fax:
Practice Address - Street 1:7 E 85TH ST
Practice Address - Street 2:SUITE A1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0440
Practice Address - Country:US
Practice Address - Phone:212-289-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019025103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist