Healthcare Provider Details

I. General information

NPI: 1457228314
Provider Name (Legal Business Name): LAURA SEBROW PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BEECHWOOD DR
LAWRENCE NY
11559-1702
US

IV. Provider business mailing address

12 BEECHWOOD DR
LAWRENCE NY
11559-1702
US

V. Phone/Fax

Practice location:
  • Phone: 646-926-2316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: