Provider Demographics
NPI:1780308072
Name:CORNELL, LAURA CATHERINE
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CATHERINE
Last Name:CORNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 STELLA LINK RD # 466
Mailing Address - Street 2:
Mailing Address - City:WEST UNIVERSITY PLACE
Mailing Address - State:TX
Mailing Address - Zip Code:77005-4342
Mailing Address - Country:US
Mailing Address - Phone:504-982-6813
Mailing Address - Fax:832-356-2743
Practice Address - Street 1:200 HOWARD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4033
Practice Address - Country:US
Practice Address - Phone:504-525-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1653103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty