Healthcare Provider Details

I. General information

NPI: 1528906344
Provider Name (Legal Business Name): LAUREL MCILROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 RIVERSIDE AVE
GLOUCESTER MA
01930-2521
US

IV. Provider business mailing address

28 RIVERSIDE AVE
GLOUCESTER MA
01930-2521
US

V. Phone/Fax

Practice location:
  • Phone: 978-387-8170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2386176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: