Provider Demographics
NPI:1740356047
Name:AYLMER, LAURA A (MSS, LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:AYLMER
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6313
Mailing Address - Country:US
Mailing Address - Phone:520-544-9890
Mailing Address - Fax:520-544-9894
Practice Address - Street 1:7740 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6313
Practice Address - Country:US
Practice Address - Phone:520-544-9890
Practice Address - Fax:520-544-9894
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904006692OtherVA STATE LICENSE
AZLCSW-15187OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS
VAMC11650Medicare PIN