Provider Demographics
NPI:1841390200
Name:GRANDE, LAURA JEANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEANNE
Last Name:GRANDE
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:BOSTON VA HEALTHCARE SYSTEM - PSYCHOLOGY (116B)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-6810
Mailing Address - Fax:857-364-4408
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:BOSTON VA HEALTHCARE SYSTEM - GRECC (182)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-6810
Practice Address - Fax:857-364-4408
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-05-20
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Provider Licenses
StateLicense IDTaxonomies
MA8624103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical