Provider Demographics
NPI:1013061738
Name:STEVENS, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MONTAGUE ST
Mailing Address - Street 2:SUITE 418
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3610
Mailing Address - Country:US
Mailing Address - Phone:718-875-5625
Mailing Address - Fax:718-875-6876
Practice Address - Street 1:44 COURT ST
Practice Address - Street 2:SUITE 900
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4405
Practice Address - Country:US
Practice Address - Phone:718-855-9890
Practice Address - Fax:718-855-9897
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW02361Medicare PIN