Provider Demographics
NPI:1669751830
Name:WAYNE, LAURA (LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WAYNE
Suffix:
Gender:F
Credentials:LICSW
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 232
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-0332
Mailing Address - Country:US
Mailing Address - Phone:781-797-0613
Mailing Address - Fax:
Practice Address - Street 1:802 MAIN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176
Practice Address - Country:US
Practice Address - Phone:781-797-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical