Provider Demographics
NPI:1790858694
Name:MIGLIORE, LAURIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:
Last Name:MIGLIORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SOQUEL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2328
Mailing Address - Country:US
Mailing Address - Phone:831-429-9412
Mailing Address - Fax:
Practice Address - Street 1:340 SOQUEL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2328
Practice Address - Country:US
Practice Address - Phone:831-429-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106HOOOOOX106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist