Basic Information
| Provider Information | |||||||||
| NPI: | 1003878992 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-R,GCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 SEMINOLE WAY | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146181317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857346826 | ||||||||
| FaxNumber: | 5859222646 | ||||||||
| Practice Location | |||||||||
| Address1: | 496 WHITE SPRUCE BLVD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146231608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857346826 | ||||||||
| FaxNumber: | 5859222646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | RO52512-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7217673 | 01 | NY | ATENA | OTHER | 137093FK | 01 | NY | PREFERRED CARE | OTHER |