Provider Demographics
NPI:1457525990
Name:WEBER, LAURI G (MA, LADC)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:G
Last Name:WEBER
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-2910
Mailing Address - Country:US
Mailing Address - Phone:203-787-2207
Mailing Address - Fax:203-773-3626
Practice Address - Street 1:501 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-2910
Practice Address - Country:US
Practice Address - Phone:203-787-2207
Practice Address - Fax:203-773-3626
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CT890101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)