Provider Demographics
NPI:1912571787
Name:LAURO, JESSICA ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:LAURO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:BALESTRIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:12 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-966-0317
Mailing Address - Fax:
Practice Address - Street 1:12 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312
Practice Address - Country:US
Practice Address - Phone:718-966-0317
Practice Address - Fax:917-791-8248
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist