Provider Demographics
NPI:1235664871
Name:IOVINE, LAURA
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:IOVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAISON DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NEW YORK
Mailing Address - Zip Code:11741
Mailing Address - Country:UM
Mailing Address - Phone:631-379-2593
Mailing Address - Fax:
Practice Address - Street 1:1 MAISON DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1313
Practice Address - Country:US
Practice Address - Phone:631-379-2593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst