Provider Demographics
NPI:1215065685
Name:DESLAURIERS, LAURIE ELAINE (LADC/MSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELAINE
Last Name:DESLAURIERS
Suffix:
Gender:F
Credentials:LADC/MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HIGH MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1841
Mailing Address - Country:US
Mailing Address - Phone:860-334-5197
Mailing Address - Fax:
Practice Address - Street 1:16 HIGH MEADOW DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1841
Practice Address - Country:US
Practice Address - Phone:860-334-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-422036101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)