Provider Demographics
NPI:1124089727
Name:REIS, LAURA E (MSW LICSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:REIS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 EAST MERRIMACK STREET
Mailing Address - Street 2:SUITE 23
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1900
Mailing Address - Country:US
Mailing Address - Phone:978-452-3711
Mailing Address - Fax:978-441-9351
Practice Address - Street 1:77 EAST MERRIMACK STREET
Practice Address - Street 2:SUITE 23
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1900
Practice Address - Country:US
Practice Address - Phone:978-452-3711
Practice Address - Fax:978-441-9351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1898167OtherMASS BEHAVIORAL HEALTH PA
MA1012240OtherFALLON
MA105813OtherMAGELLAN
MA726495OtherTUFTS
MA1857924Medicaid
MAA001040OtherHARVARD PILGRIM MH SA
MAP04661OtherBLUE CROSS MH SA
464110OtherAETNA USHC MH SA
P04661Medicare ID - Type Unspecified