Individual
LAURA FAIWISZEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Mailing address
27 CRESTWOOD DR, WEST ORANGE, NJ 07052-2003
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
025259
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2021
Last updated
12/05/2022
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