Provider Demographics
NPI:1205692928
Name:POLIZOTI, LAURA (LMHC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:POLIZOTI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1070
Mailing Address - Country:US
Mailing Address - Phone:508-410-4221
Mailing Address - Fax:
Practice Address - Street 1:4 MOUNT ROYAL AVE STE 360
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1961
Practice Address - Country:US
Practice Address - Phone:508-410-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health