Provider Demographics
NPI:1295077089
Name:COSGROVE, LAURA JEAN (MA, ATR-BC,LCAT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:MA, ATR-BC,LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W 54TH ST
Mailing Address - Street 2:SUITE 804
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5322
Mailing Address - Country:US
Mailing Address - Phone:516-603-6508
Mailing Address - Fax:
Practice Address - Street 1:161 W, 54TH ST.
Practice Address - Street 2:SUITE 804
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11019
Practice Address - Country:US
Practice Address - Phone:516-603-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001337101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional