Provider Demographics
NPI:1760464085
Name:DE LA TORRE BUENO, LAURA EMILY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:EMILY
Last Name:DE LA TORRE BUENO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPRING HILL TER
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1514
Mailing Address - Country:US
Mailing Address - Phone:617-776-8679
Mailing Address - Fax:617-623-1234
Practice Address - Street 1:21 SPRING HILL TER
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1514
Practice Address - Country:US
Practice Address - Phone:617-776-8679
Practice Address - Fax:617-623-1234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005781235OtherAETNA
NYV352GOtherEMPIRE BLUE CROSS BLUE SH
MA0005781235OtherAETNA