Provider Demographics
NPI:1649292574
Name:GUREVICH, LAURA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:GUREVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382088
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-2088
Mailing Address - Country:US
Mailing Address - Phone:857-998-0413
Mailing Address - Fax:
Practice Address - Street 1:1679 MASSACHUSETTS AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1807
Practice Address - Country:US
Practice Address - Phone:857-998-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8056103TC0700X
DCPSY1920103TC0700X
MD3446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06237OtherBCBS OF MA
MDGN84OtherBCBS OF MD
MAW10502OtherBCBS OF MA
MAW51147Medicare ID - Type Unspecified
MD836QMedicare ID - Type Unspecified