MEDICARE: MRS. LAURIE NELSON AUSTIN M.S.S.A., LCSW

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	1041C0700X	Clinical Social Worker	002496	CT

General Provider Information

NPI Number	:	1275953358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE NELSON AUSTIN M.S.S.A., LCSW

Provider Business Mailing Address
First Line	:	544 RIVERSIDE AVE STE 7
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-5732
Country	:	US
Telephone Number	:	203-451-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 RIVERSIDE AVE STE 7
Second Line	:
City	:	WESTPORT
State	:	CT
Zip	:	06880-5732
Country	:	US
Telephone Number	:	203-451-2636
Fax Number	:

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

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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