Provider Demographics
NPI:1649554601
Name:ANDERSON, LAURA (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:ANDERSON
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 1:701 W PRATT ST FL 2
Mailing Address - Street 2:UNIV OF MARYLAND ADULT OUTPATIENT PSYCHIATRY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1023
Mailing Address - Country:US
Mailing Address - Phone:410-328-6018
Mailing Address - Fax:410-328-6391
Practice Address - Street 1:701 W PRATT ST FL 2
Practice Address - Street 2:UNIV OF MARYLAND ADULT OUTPATIENT PSYCHIATRY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1023
Practice Address - Country:US
Practice Address - Phone:410-328-6018
Practice Address - Fax:410-328-6391
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04337103TC1900X
NY18441103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling