Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | P.08254 | OH |
Y | 103T00000X | Psychologist | P.08254 | OH |
NPI | 1013473917 |
---|---|
Provider Name | Dr. Laura Michelle Fogarty |
First Address | Shaker Heights, OH 44120-3508 |
Second Address | Shaker Heights, OH 44120-3508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2019 |
Last Update Date | 14/01/2022 |