Basic Information
| Provider Information | |||||||||
| NPI: | 1013285410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHOSE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1526 WALDEN AVENUE SUITE 400 | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168956700 | ||||||||
| FaxNumber: | 7168950436 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 FALL ST | ||||||||
| Address2: | |||||||||
| City: | SENECA FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131481498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155155183 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 085247 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.