Healthcare Provider Details

I. General information

NPI: 1215253166
Provider Name (Legal Business Name): LAURA HENDERSON M.ED.; LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2010
Last Update Date: 04/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOWARD ST SO. MIDDLESEX OPPORTUNITY COUNCIL, INC.
FRAMINGHAM MA
01702-8313
US

IV. Provider business mailing address

53 CLEARVIEW DR
MARLBOROUGH MA
01752-2775
US

V. Phone/Fax

Practice location:
  • Phone: 508-879-2250
  • Fax: 508-620-2637
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number313006
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: