=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063815405
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEENA LAUGHLIN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2014
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 S BRADY ST STE 205
-----------------------------------------------------
City | DU BOIS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15801-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-371-1088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 S BRADY ST STE 205
-----------------------------------------------------
City | DU BOIS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15801-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-371-1088
-----------------------------------------------------
Fax | 814-371-4966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | CW020500
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------