Provider Demographics
NPI:1760474324
Name:STANLEY, LAUREL VIRGINIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:VIRGINIA
Last Name:STANLEY
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 1:2656 W STATE ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1871
Mailing Address - Country:US
Mailing Address - Phone:716-372-4123
Mailing Address - Fax:716-372-4123
Practice Address - Street 1:2656 W STATE ST
Practice Address - Street 2:SUITE 511
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1871
Practice Address - Country:US
Practice Address - Phone:716-372-4123
Practice Address - Fax:716-372-4123
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR060193-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025419101OtherUNIVERA
NY00525904001OtherBLUE CROSS/SHIELD
NY6290304OtherINDEPENDENT HEALTH
NY230175000OtherMAGELLAN
NY230175000OtherMAGELLAN
NYS69581Medicare UPIN