Doctor Name: | MRS. LAURIE VIRGINIA VANDEUSEN |
NPI Number: | 1407003635 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | 066621-1 |
Business Practice Address: | 1277 Taylor Rd Owego, NY - 138271200 |
Business Phone Number: | 6076878929 |
Business Fax Number: | |
Mailing Address: | 16 S Woodhill Ave, BINGHAMTON |
State: | NY |
Postal Code: | 139042726 |
Phone Number: | 6077751451 |
Fax Number: | |
NPI Enumeration Date: | 08/19/2008 |
NPI Last Update Date: | 08/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041S0200X |
License Number: | 066621-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | School |
Taxonomy Definition: |