Provider Demographics
NPI:1740335306
Name:ANTOSZ, LAURENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:ANTOSZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 TWIN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1075
Mailing Address - Country:US
Mailing Address - Phone:860-742-9634
Mailing Address - Fax:860-742-9634
Practice Address - Street 1:363 MAIN ST
Practice Address - Street 2:SUITE 405
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3359
Practice Address - Country:US
Practice Address - Phone:860-428-9842
Practice Address - Fax:860-742-9634
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1651103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical