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General NPI Number Information
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NPI Number | 1033549183
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Entity Type | Individual
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Provider Name | LAURA HENNESSY
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Gender | Female
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 2517 ROUTE 35 STE 205
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City | MANASQUAN
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State | NJ
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Zip | 08736-1933
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Country | US
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Telephone | 732-416-4459
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 ROUTE 35 STE 205
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City | MANASQUAN
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State | NJ
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Zip | 08736-1933
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Country | US
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Telephone | 732-416-4459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SL05888000
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License Number State | NJ
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