Provider Demographics
NPI:1982789723
Name:MCGRAW-COOK, LAURA KIBLER (PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KIBLER
Last Name:MCGRAW-COOK
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 1:6 DANFORTH RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-7820
Mailing Address - Country:US
Mailing Address - Phone:610-252-5550
Mailing Address - Fax:610-515-6501
Practice Address - Street 1:6 DANFORTH RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-7820
Practice Address - Country:US
Practice Address - Phone:610-252-5550
Practice Address - Fax:610-515-6501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003708103TC2200X
PAPS016443103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541761126OtherEIN