Healthcare Provider Details

I. General information

NPI: 1104447440
Provider Name (Legal Business Name): LAURIE A HERRING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 8156 CHEYENNE BLVD
ANSBACH DE
91522
DE

IV. Provider business mailing address

CMR 454 BOX # 3417
APO AE
09250
DE

V. Phone/Fax

Practice location:
  • Phone: 314-520-3620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11686899-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: