Provider Demographics
NPI:1568474930
Name:WANI, LAURA DELUCA (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:DELUCA
Last Name:WANI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CAROL
Other - Last Name:WANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 BIRCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EAST QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11942-4619
Mailing Address - Country:US
Mailing Address - Phone:631-728-7275
Mailing Address - Fax:631-854-2550
Practice Address - Street 1:99B MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2607
Practice Address - Country:US
Practice Address - Phone:631-728-7275
Practice Address - Fax:631-854-2550
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-050773-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3239502OtherOXFORD
516914OtherCHCS
PIN # 7346876OtherGHI
NYR-050773-1OtherVYTRA/HIP
516914OtherEMPIRE VALUE OPTIONS
NYAA72640OtherMDNY
PIN # 7346876OtherGHI
NYR-050773-1OtherVYTRA/HIP