Provider Demographics
NPI:1891884706
Name:BARTELS, LAURA GRAND (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GRAND
Last Name:BARTELS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 KELLER LN
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2509
Mailing Address - Country:US
Mailing Address - Phone:914-693-7370
Mailing Address - Fax:
Practice Address - Street 1:19 KELLER LN
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2509
Practice Address - Country:US
Practice Address - Phone:914-693-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008868103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008868OtherLICENSE NUMBER