Provider Demographics
NPI:1811020464
Name:LAURIA, PHYLLIS (LICSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:LAURIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAVERHILL RD
Mailing Address - Street 2:SUITE 357
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-388-6191
Mailing Address - Fax:978-388-6080
Practice Address - Street 1:110 HAVERHILL RD
Practice Address - Street 2:SUITE 357
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2123
Practice Address - Country:US
Practice Address - Phone:978-388-6191
Practice Address - Fax:978-388-6080
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10210941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical