Provider Demographics
NPI:1437410560
Name:DEVINCENZI, LAURA ANN (MSED)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:DEVINCENZI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FISKE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3138
Mailing Address - Country:US
Mailing Address - Phone:718-447-4061
Mailing Address - Fax:
Practice Address - Street 1:263 FISKE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3138
Practice Address - Country:US
Practice Address - Phone:718-447-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist