Provider Demographics
NPI:1184803447
Name:SIGALOS, LAURIE (MA, CCR, CTS, CA)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:SIGALOS
Suffix:
Gender:F
Credentials:MA, CCR, CTS, CA
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:TELLEFSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCR, CTS, CA
Mailing Address - Street 1:33-11 BROADWAY STE 201
Mailing Address - Street 2:THE CHRYSALIS GROUP, LLC
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4638
Mailing Address - Country:US
Mailing Address - Phone:973-907-6923
Mailing Address - Fax:973-728-6705
Practice Address - Street 1:33-11 BROADWAY STE 201
Practice Address - Street 2:THE CHRYSALIS GROUP, LLC
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4638
Practice Address - Country:US
Practice Address - Phone:973-907-6923
Practice Address - Fax:973-728-6705
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health