Provider Demographics
NPI:1720147697
Name:HALL, LAURA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2305
Mailing Address - Country:US
Mailing Address - Phone:860-563-8800
Mailing Address - Fax:860-563-8805
Practice Address - Street 1:25 ELM ST
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2305
Practice Address - Country:US
Practice Address - Phone:860-563-8800
Practice Address - Fax:860-563-8805
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002530103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist