MEDICARE: DR. LAURA KAGAN PH.D.

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	05991	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000490249004	OTHER	NY	BSNENY
2	6894442	OTHER	NY	GHI-EMPIRE PLAN
3	V28891	OTHER	NY	EMPIRE BC BS

General Provider Information

NPI Number	:	1629050117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA KAGAN PH.D.

Provider Business Mailing Address
First Line	:	1 PINNACLE PL
Second Line	:	SUITE 200
City	:	ALBANY
State	:	NY
Zip	:	12203-3496
Country	:	US
Telephone Number	:	518-438-6864
Fax Number	:	518-438-6867

Provider Business Practice Location Address
First Line	:	1 PINNACLE PL
Second Line	:	SUITE 200
City	:	ALBANY
State	:	NY
Zip	:	12203-3496
Country	:	US
Telephone Number	:	518-438-6864
Fax Number	:	518-438-6867

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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