Individual
LAURA J HANISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
3535 MARKET ST, 2ND FLOOR, PHILADELPHIA, PA 19104-3309
(215) 662-2816
Mailing address
3624 MARKET ST, SUITE 560W, PHILADELPHIA, PA 19104-2614
(215) 662-3958
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS016506
PA
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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