Provider Demographics
NPI:1760151849
Name:LAURICELLA, ELIZABETH AM (LMSW, MS IMH-DP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AM
Last Name:LAURICELLA
Suffix:
Gender:F
Credentials:LMSW, MS IMH-DP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N SERVICE RD # LIE
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-4105
Mailing Address - Country:US
Mailing Address - Phone:516-629-7294
Mailing Address - Fax:
Practice Address - Street 1:80 N SERVICE RD # LIE
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-4105
Practice Address - Country:US
Practice Address - Phone:516-629-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1138981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical