MEDICARE: MS. LAURA MICHELLE YORK MA, ATR-BC, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor	007186	PA
3	102L00000X	Psychoanalyst
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1942607783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA MICHELLE YORK MA, ATR-BC, LPC

Provider Business Mailing Address
First Line	:	1615 W GIRARD AVE FRNT
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1637
Country	:	US
Telephone Number	:	215-490-6617
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 W GIRARD AVE FRNT
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1637
Country	:	US
Telephone Number	:	215-490-6617
Fax Number	:

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

Provider Enumeration Date	:	11/21/2014
Last Update Date	:	11/21/2014

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