Provider Demographics
NPI:1386940377
Name:LAUR, JOHN ALAN (LCSW-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:LAUR
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WALDEN MILL WAY
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2812
Mailing Address - Country:US
Mailing Address - Phone:410-499-3667
Mailing Address - Fax:
Practice Address - Street 1:57 WALDEN MILL WAY
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2812
Practice Address - Country:US
Practice Address - Phone:410-499-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD039884500Medicaid
MD01956621OtherAMERIGROUP MCO