Provider Demographics
NPI:1649487695
Name:STAMBONI, LAURA ANN (LICSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:STAMBONI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:ANN STAMBONI
Other - Last Name:GOUVEIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:809 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3918
Mailing Address - Country:US
Mailing Address - Phone:617-674-2288
Mailing Address - Fax:
Practice Address - Street 1:809 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3918
Practice Address - Country:US
Practice Address - Phone:617-674-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1134741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical