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General NPI Number Information
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NPI Number | 1851874192
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Entity Type | Individual
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Provider Name | LAURA KAY PEREDNIA LCSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 301 COUNTRY CLUB RD
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City | AVON
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State | CT
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Zip | 06001-2516
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Country | US
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Telephone | 860-673-8610
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Fax |
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Provider Business Mailing Address
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Address Line | 43 SILVER ST
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City | NORTH GRANBY
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State | CT
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Zip | 06060-1508
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Country | US
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Telephone | 860-817-5848
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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 | 116255
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007769
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License Number State | CT
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