Provider Demographics
NPI:1417545807
Name:MCLENNON-LAURENT, ANTONELLA
Entity Type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:
Last Name:MCLENNON-LAURENT
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 1:27 SIEMON COMPANY DR STE 302W
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2654
Mailing Address - Country:US
Mailing Address - Phone:203-400-0031
Mailing Address - Fax:
Practice Address - Street 1:27 SIEMON COMPANY DR STE 302W
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2654
Practice Address - Country:US
Practice Address - Phone:203-400-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst