Healthcare Provider Details

I. General information

NPI: 1346518750
Provider Name (Legal Business Name): LAURA MARIE WHITE-HENDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 THORNTON RD
WURTSBORO NY
12790-5319
US

IV. Provider business mailing address

PO BOX 343
SPRING GLEN NY
12483-0343
US

V. Phone/Fax

Practice location:
  • Phone: 845-272-1055
  • Fax:
Mailing address:
  • Phone: 845-272-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number076932
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092130
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: