Healthcare Provider Details

I. General information

NPI: 1205673431
Provider Name (Legal Business Name): LAURA BARCLAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 DEVONSHIRE ST STE 801&802
BOSTON MA
02110-1407
US

IV. Provider business mailing address

317 W 4TH ST
BOSTON MA
02127-4672
US

V. Phone/Fax

Practice location:
  • Phone: 781-725-5625
  • Fax:
Mailing address:
  • Phone: 347-880-0476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00988
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10003543
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: