Provider Demographics
NPI:1295859304
Name:DELAURA, JOANNE A (ATR-BC, LCAT)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:A
Last Name:DELAURA
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6318
Mailing Address - Country:US
Mailing Address - Phone:516-825-1370
Mailing Address - Fax:
Practice Address - Street 1:94 S GROVE ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6318
Practice Address - Country:US
Practice Address - Phone:516-825-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000468221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2934OtherCREDENTIALED PROFESSIONAL
NY000468OtherCREATIVE ART THERAPIST
NY86 029OtherBOARD CERTIFIED