Provider Demographics
NPI:1255817789
Name:GONCALVES, LAURA C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:C
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4668 DEALTREY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5861
Mailing Address - Country:US
Mailing Address - Phone:570-233-3153
Mailing Address - Fax:
Practice Address - Street 1:4668 DEALTREY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5861
Practice Address - Country:US
Practice Address - Phone:570-233-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0224651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALSW133415OtherSTATE LIS