Provider Demographics
NPI:1982782397
Name:HARRISON, LAURA FADELY (MSW LCSWC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:FADELY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MSW LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 RIVERSIDE DR STE B101
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4701
Mailing Address - Country:US
Mailing Address - Phone:443-978-8687
Mailing Address - Fax:
Practice Address - Street 1:560 RIVERSIDE DR STE B101
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:443-978-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD109281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522156095OtherCIGNA
MD522156095OtherUNITED BEHAVIORAL HEALTH
MD522156095OtherCIGNA
100088748OtherAMERICAN PSYCH SYSTEM
724330OtherNCPPO
MD7840093OtherAETNA
MD346646OtherMANAGED HEALTH NETWORK/TRICARE
MD61582501OtherCAREFIRST BCBS PIN
DCR968OtherCAREFIRST FEDERAL GROUP
DC0010OtherCAREFIRST FEDERAL PIN
MD7374385OtherAETNA
MDLM49EAOtherCAREFIRST BCBS GROUP
MDR968OtherCAREFIRST
MD476737000OtherMAGELLAN PIN
MD609550001Medicaid
2101083OtherUNITED HEALTH CARE MAMSI
517251OtherUHC MAMSI GROUP #
MD346646OtherMANAGED HEALTH NETWORK/TRICARE
MD61582501OtherCAREFIRST BCBS PIN