Provider Demographics
NPI:1740669019
Name:LAURIE E ETZRODT
Entity type:Organization
Organization Name:LAURIE E ETZRODT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ETZRODT
Authorized Official - Suffix:
Authorized Official - Credentials:MSS,LCSW
Authorized Official - Phone:215-493-8896
Mailing Address - Street 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:304A
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7706
Mailing Address - Country:US
Mailing Address - Phone:215-493-8896
Mailing Address - Fax:215-340-1867
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:304A
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:215-493-8896
Practice Address - Fax:215-340-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO144881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty