Provider Demographics
NPI:1992961627
Name:KOHLEY, LAURA LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LYNN
Last Name:KOHLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-1636
Mailing Address - Country:US
Mailing Address - Phone:203-616-0606
Mailing Address - Fax:845-278-6905
Practice Address - Street 1:ROUTE 202 & LOVELL STREET
Practice Address - Street 2:
Practice Address - City:LINCOLNDALE
Practice Address - State:NY
Practice Address - Zip Code:10540
Practice Address - Country:US
Practice Address - Phone:203-616-0606
Practice Address - Fax:845-278-6905
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0756391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY075639OtherLCSW