Healthcare Provider Details

I. General information

NPI: 1942607783
Provider Name (Legal Business Name): LAURA MICHELLE YORK MA, ATR-BC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 W GIRARD AVE FRNT
PHILADELPHIA PA
19130-1637
US

IV. Provider business mailing address

1615 W GIRARD AVE FRNT
PHILADELPHIA PA
19130-1637
US

V. Phone/Fax

Practice location:
  • Phone: 215-490-6617
  • Fax:
Mailing address:
  • Phone: 215-490-6617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007186
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: