Provider Demographics
NPI:1740312396
Name:HARVEY, LAURETTE EILEEN (MSW)
Entity type:Individual
Prefix:
First Name:LAURETTE
Middle Name:EILEEN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-4244
Mailing Address - Country:US
Mailing Address - Phone:301-530-2851
Mailing Address - Fax:
Practice Address - Street 1:8609 2ND AVE STE 307B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3361
Practice Address - Country:US
Practice Address - Phone:301-588-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD639531Medicare ID - Type Unspecified