Provider Demographics
NPI:1851874192
Name:PEREDNIA, LAURA KAY (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KAY
Last Name:PEREDNIA
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-1508
Mailing Address - Country:US
Mailing Address - Phone:860-817-5848
Mailing Address - Fax:
Practice Address - Street 1:301 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2516
Practice Address - Country:US
Practice Address - Phone:860-673-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162551041C0700X
CT0077691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical