Provider Demographics
NPI:1811135619
Name:EASTMAN-FOLLIS, LAURA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:EASTMAN-FOLLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WHITE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1626
Mailing Address - Country:US
Mailing Address - Phone:845-233-4704
Mailing Address - Fax:845-229-9579
Practice Address - Street 1:31 WHITE OAKS RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1626
Practice Address - Country:US
Practice Address - Phone:845-233-4704
Practice Address - Fax:845-229-9579
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07782001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1811135619Medicaid