Provider Demographics
NPI:1053610592
Name:BRONSTEIN, LAURA LEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:BRONSTEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PERRIN CIR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:VA
Mailing Address - Zip Code:23696-2413
Mailing Address - Country:US
Mailing Address - Phone:757-369-8865
Mailing Address - Fax:
Practice Address - Street 1:6515 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-2182
Practice Address - Country:US
Practice Address - Phone:757-877-9140
Practice Address - Fax:757-877-3925
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040075991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical