| Doctor Name: | LAURA HENNESSY |
| NPI Number: | 1033549183 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 44SL05888000 |
| Business Practice Address: | 270 Highway 35 Red Bank, NJ - 077015920 |
| Business Phone Number: | 7328422000 |
| Business Fax Number: | 7322190474 |
| Mailing Address: | 270 Highway 35, RED BANK |
| State: | NJ |
| Postal Code: | 077015920 |
| Phone Number: | 7328422000 |
| Fax Number: | 7322190474 |
| NPI Enumeration Date: | 11/26/2013 |
| NPI Last Update Date: | 11/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 44SL05888000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |