Provider Demographics
NPI:1215175914
Name:BORUCKI, LAURA ANNE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:BORUCKI
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 1:1705 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1800
Mailing Address - Country:US
Mailing Address - Phone:412-464-4781
Mailing Address - Fax:
Practice Address - Street 1:1705 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1800
Practice Address - Country:US
Practice Address - Phone:412-464-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health