Healthcare Provider Details

I. General information

NPI: 1215065685
Provider Name (Legal Business Name): LAURIE ELAINE DESLAURIERS LADC/MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HIGH MEADOW DR
PLAINFIELD CT
06374-1841
US

IV. Provider business mailing address

16 HIGH MEADOW DR
PLAINFIELD CT
06374-1841
US

V. Phone/Fax

Practice location:
  • Phone: 860-334-5197
  • Fax:
Mailing address:
  • Phone: 860-334-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number03-422036
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: