Healthcare Provider Details

I. General information

NPI: 1134566524
Provider Name (Legal Business Name): LAURA KWASNIEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2013
Last Update Date: 12/02/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 STATE ROUTE 101 STE 11
BEDFORD NH
03110-5031
US

IV. Provider business mailing address

535 8TH AVE FL 9
NEW YORK NY
10018-2486
US

V. Phone/Fax

Practice location:
  • Phone: 603-471-2522
  • Fax:
Mailing address:
  • Phone: 603-471-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: