MEDICARE: MS. LAURIE ANNE MCBAIN CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	51687-1	NY

General Provider Information

NPI Number	:	1275644858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE ANNE MCBAIN CSW

Provider Business Mailing Address
First Line	:	250 MCCULLOUGH PL
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-3718
Country	:	US
Telephone Number	:	518-376-3402
Fax Number	:	518-479-4090

Provider Business Practice Location Address
First Line	:	726 COLUMBIA TPKE
Second Line	:
City	:	EAST GREENBUSH
State	:	NY
Zip	:	12061-2215
Country	:	US
Telephone Number	:	518-376-3402
Fax Number	:	518-479-4090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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