Provider Demographics
NPI:1215436886
Name:CHASE, LAURA ROSE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ROSE
Last Name:CHASE
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5101
Mailing Address - Country:US
Mailing Address - Phone:631-714-4100
Mailing Address - Fax:
Practice Address - Street 1:3601 HEMPSTEAD TPKE STE 405
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1331
Practice Address - Country:US
Practice Address - Phone:631-714-4100
Practice Address - Fax:631-714-4191
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406353363LP0808X
NY342818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily