Provider Demographics
NPI:1740326107
Name:HARSCH, LAURA BEATRICE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BEATRICE
Last Name:HARSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EMBER LN
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-2209
Mailing Address - Country:US
Mailing Address - Phone:631-539-6370
Mailing Address - Fax:631-539-6370
Practice Address - Street 1:3 EMBER LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2209
Practice Address - Country:US
Practice Address - Phone:631-539-6370
Practice Address - Fax:631-539-6370
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055602-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical