Provider Demographics
NPI:1952529489
Name:LASCU, LAURETTA ELISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURETTA
Middle Name:ELISA
Last Name:LASCU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8172 TONAWANDA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1043
Mailing Address - Country:US
Mailing Address - Phone:716-636-6067
Mailing Address - Fax:
Practice Address - Street 1:8610 TRANSIT RD STE 2
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2608
Practice Address - Country:US
Practice Address - Phone:716-204-0100
Practice Address - Fax:716-204-2761
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000525796001OtherHEALTH NOW
NY00020952501 PIN#1052OtherUNIVERA
NY6110861OtherINDEPENDENT HEALTH
NYS55142Medicare UPIN
NY00020952501 PIN#1052OtherUNIVERA