Provider Demographics
NPI:1780989392
Name:PERMUTER-NGUYEN, LAURA JANE (MA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANE
Last Name:PERMUTER-NGUYEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W BOYNTON BEACH BLVD
Mailing Address - Street 2:#9-105
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3665
Mailing Address - Country:US
Mailing Address - Phone:314-954-3763
Mailing Address - Fax:
Practice Address - Street 1:815 W BOYNTON BEACH BLVD
Practice Address - Street 2:#9-105
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3665
Practice Address - Country:US
Practice Address - Phone:314-954-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst