Provider Demographics
NPI:1053764258
Name:GIRARD, LAURA (LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GIRARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HIGHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-3937
Mailing Address - Country:US
Mailing Address - Phone:508-679-8642
Mailing Address - Fax:
Practice Address - Street 1:195 HIGHRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-3937
Practice Address - Country:US
Practice Address - Phone:508-679-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1260771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17807901467Medicaid