Healthcare Provider Details

I. General information

NPI: 1356345375
Provider Name (Legal Business Name): LAURA D BYKOFSKY LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MAPLE AVE
SARATOGA SPRINGS NY
12866-5502
US

IV. Provider business mailing address

409 MAPLE AVE
SARATOGA SPRINGS NY
12866-5502
US

V. Phone/Fax

Practice location:
  • Phone: 518-583-3530
  • Fax: 518-583-2040
Mailing address:
  • Phone: 518-583-3530
  • Fax: 518-583-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR040449-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: