Provider Demographics
NPI:1245389220
Name:MAYNARD, LAURI (LMHC)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PAWCATUCK AVE
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-2432
Mailing Address - Country:US
Mailing Address - Phone:401-596-8830
Mailing Address - Fax:401-596-8802
Practice Address - Street 1:6 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3138
Practice Address - Country:US
Practice Address - Phone:860-235-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health