Healthcare Provider Details

I. General information

NPI: 1275644858
Provider Name (Legal Business Name): LAURIE ANNE MCBAIN CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 COLUMBIA TPKE
EAST GREENBUSH NY
12061-2215
US

IV. Provider business mailing address

250 MCCULLOUGH PL
RENSSELAER NY
12144-3718
US

V. Phone/Fax

Practice location:
  • Phone: 518-376-3402
  • Fax: 518-479-4090
Mailing address:
  • Phone: 518-376-3402
  • Fax: 518-479-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number51687-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: