Provider Demographics
NPI:1164667010
Name:LAURENTI, MACLE EMILY (MA)
Entity Type:Individual
Prefix:
First Name:MACLE
Middle Name:EMILY
Last Name:LAURENTI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:441 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3043
Practice Address - Country:US
Practice Address - Phone:516-804-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool