Provider Demographics
NPI:1134836216
Name:BOTRUS, LAUREAN (PSY D)
Entity type:Individual
Prefix:DR
First Name:LAUREAN
Middle Name:
Last Name:BOTRUS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E BROAD ST STE 510
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5964
Mailing Address - Country:US
Mailing Address - Phone:610-865-4300
Mailing Address - Fax:
Practice Address - Street 1:1 E BROAD ST STE 510
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5964
Practice Address - Country:US
Practice Address - Phone:610-865-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical