Provider Demographics
NPI:1811473341
Name:GERHARD, LAURA B (CRC, MAC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:GERHARD
Suffix:
Gender:F
Credentials:CRC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AMELIA CT
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:NY
Mailing Address - Zip Code:12123-2901
Mailing Address - Country:US
Mailing Address - Phone:518-961-3222
Mailing Address - Fax:
Practice Address - Street 1:8 AMELIA CT
Practice Address - Street 2:
Practice Address - City:NASSAU
Practice Address - State:NY
Practice Address - Zip Code:12123-2901
Practice Address - Country:US
Practice Address - Phone:518-961-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00036477225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00036477OtherCOMMISSION ON REHABILITATION COUNSELOR CERTIFICATION