Provider Demographics
NPI:1255631990
Name:DANA, LAURA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:DANA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1261
Mailing Address - Country:US
Mailing Address - Phone:732-817-0103
Mailing Address - Fax:
Practice Address - Street 1:1118 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1261
Practice Address - Country:US
Practice Address - Phone:732-817-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00557300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0023701OtherAGENCY MEDICAID PROVIDER #
NJ527486OtherAGENCY MEDICARE PROVIDER #