Provider Demographics
NPI:1194876953
Name:AKEKE MSW LICSW, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AKEKE MSW LICSW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BELMONT ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4430
Mailing Address - Country:US
Mailing Address - Phone:508-584-9161
Mailing Address - Fax:
Practice Address - Street 1:1350 BELMONT ST STE 107
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4430
Practice Address - Country:US
Practice Address - Phone:508-584-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144421041C0700X
MA20306161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherBEACON HEALTH STRATEGIES
N/AOtherBEACON HEALTH STRATEGIES