MEDICARE: LAUREL RIVER COUNSELING LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770244360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL RIVER COUNSELING LLC

Provider Business Mailing Address
First Line	:	25 OMOORE AVE
Second Line	:
City	:	MAYNARD
State	:	MA
Zip	:	01754-1936
Country	:	US
Telephone Number	:	789-793-3481
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 STOW RD UNIT B
Second Line	:
City	:	BOXBOROUGH
State	:	MA
Zip	:	01719-1845
Country	:	US
Telephone Number	:	978-793-3481
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. LAURA MAUROY
Credential	:
Telephone Number	:	978-793-3481

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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Directions to “LAUREL RIVER COUNSELING LLC ” Practice Location

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