Provider Demographics
NPI:1013473917
Name:FOGARTY, LAURA MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELLE
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3294 VAN AKEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3508
Mailing Address - Country:US
Mailing Address - Phone:216-647-9382
Mailing Address - Fax:
Practice Address - Street 1:3294 VAN AKEN BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-3508
Practice Address - Country:US
Practice Address - Phone:216-647-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.08254103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist