Provider Demographics
NPI:1790088300
Name:MENDELSOHN, LAURIE (PHD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MENDELSOHN
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 1:62 PIERREPONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2452
Mailing Address - Country:US
Mailing Address - Phone:917-301-1607
Mailing Address - Fax:
Practice Address - Street 1:62 PIERREPONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2452
Practice Address - Country:US
Practice Address - Phone:917-301-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical