Individual
DR. LAURA ALISON ELLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
12 RENWICK AVE, SUITE 103, KINGS PARK, NY 11754-3709
(516) 635-6186
Mailing address
39 DEHAN ST, SMITHTOWN, NY 11787-1034
(631) 656-9507
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
014960
NY
103TC0700X
Clinical Psychologist
Primary
014960
NY
103TC2200X
Clinical Child & Adolescent Psychologist
014960
NY
103TE1100X
Exercise & Sports Psychologist
014960
NY
103TF0000X
Family Psychologist
014960
NY
103TH0004X
Health Psychologist
014960
NY
103TH0100X
Health Service Psychologist
014960
NY
103TP2701X
Group Psychotherapy Psychologist
014960
NY
106H00000X
Marriage & Family Therapist
014960
NY
Other
Enumeration date
07/19/2006
Last updated
08/17/2007
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