Healthcare Provider Details

I. General information

NPI: 1114340056
Provider Name (Legal Business Name): LAURA REPCHECK LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

IV. Provider business mailing address

1 COOPER PLZ
CAMDEN NJ
08103-1461
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2321
  • Fax:
Mailing address:
  • Phone: 856-342-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05939600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: