Provider Demographics
NPI:1003290149
Name:LUNGARELLI, LAURA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LUNGARELLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421-1330
Mailing Address - Country:US
Mailing Address - Phone:757-665-5041
Mailing Address - Fax:757-665-5888
Practice Address - Street 1:18469 DUNNE AVE
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-5041
Practice Address - Fax:757-665-5888
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical