MEDICARE: MRS. LAURIE MCKEIGHAN BELANGER LCSWR

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	076893-1	NY

General Provider Information

NPI Number	:	1528404936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE MCKEIGHAN BELANGER LCSWR

Provider Business Mailing Address
First Line	:	9750 TRANSIT RD
Second Line	:	EAST AMHERST PSYCHOLOGY GROUP LLP
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1311
Country	:	US
Telephone Number	:	716-906-9625
Fax Number	:	716-636-4501

Provider Business Practice Location Address
First Line	:	9750 TRANSIT RD
Second Line	:	EAST AMHERST PSYCHOLOGY GROUP LLP
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1311
Country	:	US
Telephone Number	:	716-906-9625
Fax Number	:	716-636-4501

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

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	01/12/2017

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