Healthcare Provider Details

I. General information

NPI: 1376329003
Provider Name (Legal Business Name): LAURIE ANN PARSONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 COTTONWOOD LN
RIVER GROVE IL
60171-0020
US

IV. Provider business mailing address

217 SUMMIT AVE, SUITE 1, PMB 1044
JERSEY CITY NJ
07304-3109
US

V. Phone/Fax

Practice location:
  • Phone: 850-792-7953
  • Fax:
Mailing address:
  • Phone: 850-792-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC06641400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: