Provider Demographics
NPI:1902199409
Name:GAMBARDELLA, LAURIE L (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:L
Last Name:GAMBARDELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TAMARACK CT
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-6413
Mailing Address - Country:US
Mailing Address - Phone:336-508-1298
Mailing Address - Fax:
Practice Address - Street 1:11 TAMARACK CT
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-6413
Practice Address - Country:US
Practice Address - Phone:336-508-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA003724101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator