Provider Demographics
NPI:1851666242
Name:RENAE, LAURA M (MA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:RENAE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-0032
Mailing Address - Country:US
Mailing Address - Phone:215-257-6551
Mailing Address - Fax:215-257-6570
Practice Address - Street 1:807 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1549
Practice Address - Country:US
Practice Address - Phone:215-257-6551
Practice Address - Fax:215-257-6570
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health