Provider Demographics
NPI:1922203918
Name:MEYERS, LAURA VALLISH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:VALLISH
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 46TH ST
Mailing Address - Street 2:APT. 5M
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1873
Mailing Address - Country:US
Mailing Address - Phone:917-282-9391
Mailing Address - Fax:917-677-8651
Practice Address - Street 1:110 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5063
Practice Address - Country:US
Practice Address - Phone:917-282-9391
Practice Address - Fax:917-677-8651
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist