Healthcare Provider Details

I. General information

NPI: 1073575049
Provider Name (Legal Business Name): LAURA J HENSELER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST # 11A
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

3461 S COUNTY TRL
EAST GREENWICH RI
02818-1465
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-8770
  • Fax: 401-793-8709
Mailing address:
  • Phone: 401-471-6760
  • Fax: 401-471-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10303
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD10303
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD10303
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: