Provider Demographics
NPI:1053128116
Name:LAURIE, JOSEPH JAMES (LPC, ADC INTERN)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:LAURIE
Suffix:
Gender:M
Credentials:LPC, ADC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SHADY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1819
Mailing Address - Country:US
Mailing Address - Phone:848-224-1210
Mailing Address - Fax:
Practice Address - Street 1:144 MILL ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-5156
Practice Address - Country:US
Practice Address - Phone:848-208-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01065900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional