Provider Demographics
NPI:1821744343
Name:LAUREL & OAK PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:LAUREL & OAK PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:646-662-5380
Mailing Address - Street 1:4800 ROLAND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2347
Mailing Address - Country:US
Mailing Address - Phone:646-662-5380
Mailing Address - Fax:
Practice Address - Street 1:4800 ROLAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2347
Practice Address - Country:US
Practice Address - Phone:646-662-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty