Provider Demographics
NPI:1538593116
Name:UPPENDAHL, LAURA J (LCSW, LADC1)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:UPPENDAHL
Suffix:
Gender:F
Credentials:LCSW, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 CAUSEWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2148
Mailing Address - Country:US
Mailing Address - Phone:617-248-1009
Mailing Address - Fax:617-248-1014
Practice Address - Street 1:251 CAUSEWAY ST FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-248-1009
Practice Address - Fax:617-248-1014
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist