Provider Demographics
NPI:1457802126
Name:OTT, LAURA (LMSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3871 HARLEM RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1946
Mailing Address - Country:US
Mailing Address - Phone:716-586-2230
Mailing Address - Fax:716-586-2212
Practice Address - Street 1:3871 HARLEM RD STE 206
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14215-1946
Practice Address - Country:US
Practice Address - Phone:716-586-2230
Practice Address - Fax:716-586-2212
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098393-1104100000X
NYNY089231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker