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General NPI Number Information
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NPI Number | 1548464043
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Entity Type | Individual
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Provider Name | LAURA MADLYN HARRISON LCADC
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 234 MAPLE AVE
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City | RED BANK
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State | NJ
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Zip | 07701-1731
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Country | US
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Telephone | 732-747-1035
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Fax | 732-747-1069
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Provider Business Mailing Address
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Address Line | 234 MAPLE AVE PO BOX 812
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City | RED BANK
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State | NJ
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Zip | 07701-1731
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Country | US
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Telephone | 732-747-1035
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Fax | 732-747-1069
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 37LC00126700
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License Number State | NJ
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