Provider Demographics
NPI:1437863768
Name:MONGELLUZZI, LANIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:LANIE
Middle Name:ELIZABETH
Last Name:MONGELLUZZI
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 1:3181 SHARPE LN
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9241
Mailing Address - Country:US
Mailing Address - Phone:727-771-3282
Mailing Address - Fax:
Practice Address - Street 1:3181 SHARPE LN
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9241
Practice Address - Country:US
Practice Address - Phone:727-736-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst