Provider Demographics
NPI:1760790190
Name:SHOCKLEY, LAURA BRITTO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BRITTO
Last Name:SHOCKLEY
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 1:300 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2246
Mailing Address - Country:US
Mailing Address - Phone:518-884-7290
Mailing Address - Fax:518-884-7286
Practice Address - Street 1:300 WOOD RD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2246
Practice Address - Country:US
Practice Address - Phone:518-884-7290
Practice Address - Fax:518-884-7286
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044447-11041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool