Provider Demographics
NPI:1528505997
Name:GATTUSO, LAURA (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GATTUSO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:TRANQUILITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07879-0129
Mailing Address - Country:US
Mailing Address - Phone:908-246-6929
Mailing Address - Fax:
Practice Address - Street 1:33 KENNEDY ROAD
Practice Address - Street 2:SUITE 33A
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821
Practice Address - Country:US
Practice Address - Phone:908-246-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00576000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional