Provider Demographics
NPI:1821646076
Name:LAUCELLA, JONATHAN THOMAS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:THOMAS
Last Name:LAUCELLA
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 W ARCH HAVEN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2078
Mailing Address - Country:US
Mailing Address - Phone:317-656-9613
Mailing Address - Fax:317-988-5525
Practice Address - Street 1:1332 W ARCH HAVEN AVE STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2078
Practice Address - Country:US
Practice Address - Phone:317-656-9613
Practice Address - Fax:317-988-5525
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009643A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical