Provider Demographics
NPI:1982981122
Name:LAIDLAW, IAN R (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:R
Last Name:LAIDLAW
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 W NYACK RD STE 43
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2241
Mailing Address - Country:US
Mailing Address - Phone:845-521-8817
Mailing Address - Fax:
Practice Address - Street 1:719 W NYACK RD STE 43
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2241
Practice Address - Country:US
Practice Address - Phone:845-521-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0825911041C0700X
NYR0825911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04173906Medicaid