Basic Information
| Provider Information | |||||||||
| NPI: | 1467402958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATZ | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1156 N BROADWAY | ||||||||
| Address2: | ANDRUS CHILDREN'S CENTER | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107011108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149653700 | ||||||||
| FaxNumber: | 9149653883 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 S BROADWAY | ||||||||
| Address2: | ANDRUS CHILDREN'S CENTER MENTAL HEALTH DIVISION | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107013712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149681663 | ||||||||
| FaxNumber: | 9149651664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 074634 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 00074634 | 05 | NY | MEDICAID |