1528404936 NPI number — MRS. LAURIE MCKEIGHAN BELANGER LCSWR

Table of content: MRS. LAURIE MCKEIGHAN BELANGER LCSWR (NPI 1528404936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528404936 NPI number — MRS. LAURIE MCKEIGHAN BELANGER LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELANGER
Provider First Name:
LAURIE
Provider Middle Name:
MCKEIGHAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528404936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9750 TRANSIT RD
Provider Second Line Business Mailing Address:
EAST AMHERST PSYCHOLOGY GROUP LLP
Provider Business Mailing Address City Name:
EAST AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14051-1311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-906-9625
Provider Business Mailing Address Fax Number:
716-636-4501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9750 TRANSIT RD
Provider Second Line Business Practice Location Address:
EAST AMHERST PSYCHOLOGY GROUP LLP
Provider Business Practice Location Address City Name:
EAST AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14051-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-906-9625
Provider Business Practice Location Address Fax Number:
716-636-4501
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  076893-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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