Provider Demographics
NPI:1699207746
Name:LAURA MAURIELLO, LLC
Entity Type:Organization
Organization Name:LAURA MAURIELLO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-890-4899
Mailing Address - Street 1:400 N LA SALLE DR
Mailing Address - Street 2:#1507
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8539
Mailing Address - Country:US
Mailing Address - Phone:630-890-4899
Mailing Address - Fax:312-546-7065
Practice Address - Street 1:400 N LA SALLE DR
Practice Address - Street 2:#1507
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8539
Practice Address - Country:US
Practice Address - Phone:630-890-4899
Practice Address - Fax:312-546-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490179731041C0700X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty