Provider Demographics
NPI:1790909356
Name:CANEVALI, LAURIE M (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:M
Last Name:CANEVALI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18203 KITCHEN HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2423
Mailing Address - Country:US
Mailing Address - Phone:240-671-2734
Mailing Address - Fax:301-972-3226
Practice Address - Street 1:1620 ELTON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1740
Practice Address - Country:US
Practice Address - Phone:301-439-7191
Practice Address - Fax:301-439-1169
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD124821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9403766OtherPHCS
DCF1270029OtherBLUE CROSS BLUE SHIELD
MD2145019OtherMAMSI UNITED HEALTH
MDLV12-647570-01OtherBLUE CROSS BLUE SHIELD
MD7895759OtherAETNA
DCF1270029OtherBLUE CROSS BLUE SHIELD