Provider Demographics
NPI:1972811289
Name:HALVORSEN, LAURA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:HALVORSEN
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 1:191 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3154
Mailing Address - Country:US
Mailing Address - Phone:978-254-4321
Mailing Address - Fax:
Practice Address - Street 1:191 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3154
Practice Address - Country:US
Practice Address - Phone:978-254-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1351103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical