MEDICARE: DR. LAURIE BURDA MASTROGIANIS PHD, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301013176	MI

General Provider Information

NPI Number	:	1083707137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE BURDA MASTROGIANIS PHD, LPC

Provider Business Mailing Address
First Line	:	63959 INVERNESS DR
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2850
Country	:	US
Telephone Number	:	586-540-1094
Fax Number	:

Provider Business Practice Location Address
First Line	:	44056 MOUND RD 105
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1357
Country	:	US
Telephone Number	:	586-540-1094
Fax Number	:	586-816-0154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	02/12/2026

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