Healthcare Provider Details

I. General information

NPI: 1255081055
Provider Name (Legal Business Name): LAURA PERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17893 W MOUNTAIN SKY AVE
GOODYEAR AZ
85338-6521
US

IV. Provider business mailing address

17893 W MOUNTAIN SKY AVE
GOODYEAR AZ
85338-6521
US

V. Phone/Fax

Practice location:
  • Phone: 201-247-3812
  • Fax:
Mailing address:
  • Phone: 201-247-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06072000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: