| Doctor Name: | DR. LAURA ALISON ELLICK |
| NPI Number: | 1407875172 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 014960 |
| Business Practice Address: | 12 Renwick Ave Suite 103 Kings Park, NY - 117543709 |
| Business Phone Number: | 5166356186 |
| Business Fax Number: | |
| Mailing Address: | 39 Dehan St, SMITHTOWN |
| State: | NY |
| Postal Code: | 117871034 |
| Phone Number: | 6316569507 |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 08/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 014960 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |