Healthcare Provider Details

I. General information

NPI: 1013285410
Provider Name (Legal Business Name): LAURA L GHOSE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FALL ST
SENECA FALLS NY
13148-1498
US

IV. Provider business mailing address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

V. Phone/Fax

Practice location:
  • Phone: 315-515-5183
  • Fax:
Mailing address:
  • Phone: 716-895-6700
  • Fax: 716-895-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: