Provider Demographics
NPI:1588010425
Name:DELAURENTIS, LYNN P (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:P
Last Name:DELAURENTIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-1717
Mailing Address - Country:US
Mailing Address - Phone:609-481-5830
Mailing Address - Fax:
Practice Address - Street 1:119 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-1717
Practice Address - Country:US
Practice Address - Phone:609-481-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00575000101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health