Provider Demographics
NPI:1174580609
Name:GILLESPIE, LAURIE ANN (MSS, LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:JAMISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSS, LCSW
Mailing Address - Street 1:8226 ARDLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3414
Mailing Address - Country:US
Mailing Address - Phone:610-547-7174
Mailing Address - Fax:
Practice Address - Street 1:8226 ARDLEIGH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3414
Practice Address - Country:US
Practice Address - Phone:610-547-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123303104100000X
PAED HM SCHOOL VISITOR1041S0200X
PACW1233031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical