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General NPI Number Information
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NPI Number | 1700692563
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Entity Type | Individual
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Provider Name | LAURA JANE MCCONVILLE LSW
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 569 BROADWAY
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City | WESTWOOD
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State | NJ
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Zip | 07675-1663
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Country | US
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Telephone | 201-957-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E SALEM ST
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City | HACKENSACK
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State | NJ
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Zip | 07601-7427
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Country | US
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Telephone | 201-646-0333
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL07035600
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License Number State | NJ
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