Provider Demographics
NPI:1891710349
Name:SPIES, LAURI M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:M
Last Name:SPIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070
Mailing Address - Country:US
Mailing Address - Phone:201-615-3299
Mailing Address - Fax:201-933-6026
Practice Address - Street 1:55 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070
Practice Address - Country:US
Practice Address - Phone:201-615-3299
Practice Address - Fax:201-933-6026
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051902001041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006602Medicaid
NJ067956AAFMedicare ID - Type Unspecified