Provider Demographics
NPI:1952400913
Name:BREWER, LAURA CATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CATHERINE
Last Name:BREWER
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 1:2413 AUGER PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2200
Mailing Address - Country:US
Mailing Address - Phone:804-379-9120
Mailing Address - Fax:
Practice Address - Street 1:1503 SANTA ROSA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5105
Practice Address - Country:US
Practice Address - Phone:804-673-0010
Practice Address - Fax:804-673-0100
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003988103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109263FCOtherPREFERRED CARE
NYP010014020OtherBLUE CHOICE
NY7481378OtherAETNA
NYP030014020OtherBLUE CROSS BLUE SHIELD
NYRA0190Medicare ID - Type Unspecified
NY109263FCOtherPREFERRED CARE