Provider Demographics
NPI:1104256494
Name:ADAMIC, LAURA K (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:ADAMIC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MOSS HILL RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3009
Mailing Address - Country:US
Mailing Address - Phone:617-834-2647
Mailing Address - Fax:
Practice Address - Street 1:116 MOSS HILL RD
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3009
Practice Address - Country:US
Practice Address - Phone:617-834-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical