Provider Demographics
NPI:1134338585
Name:OTCHY, LAURA CRONAN (MHC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:CRONAN
Last Name:OTCHY
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:CRONAN
Other - Last Name:OTCHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:669 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2703
Mailing Address - Country:US
Mailing Address - Phone:973-762-4185
Mailing Address - Fax:
Practice Address - Street 1:669 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2703
Practice Address - Country:US
Practice Address - Phone:973-762-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00377100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health