Provider Demographics
NPI:1881869022
Name:NISENSON, LAURA GAIL (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GAIL
Last Name:NISENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E WASHINGTON ST
Mailing Address - Street 2:SUITE 101D
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2024
Mailing Address - Country:US
Mailing Address - Phone:734-623-0895
Mailing Address - Fax:
Practice Address - Street 1:425 E WASHINGTON ST
Practice Address - Street 2:SUITE 101D
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2024
Practice Address - Country:US
Practice Address - Phone:734-623-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009644103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist