Provider Demographics
NPI:1457756868
Name:MORTIMER, JOANNE LAURA (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:LAURA
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LAURA
Other - Last Name:MOSKOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:297 KNOLLWOOD RD.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1833
Mailing Address - Country:US
Mailing Address - Phone:914-686-6891
Mailing Address - Fax:203-344-9104
Practice Address - Street 1:297 KNOLLWOOD RD.
Practice Address - Street 2:SUITE 305
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1833
Practice Address - Country:US
Practice Address - Phone:914-686-6891
Practice Address - Fax:203-344-9104
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003198-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health