Provider Demographics
NPI:1932652542
Name:GINA LAMICELLA INC.
Entity Type:Organization
Organization Name:GINA LAMICELLA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMICELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MSSPED
Authorized Official - Phone:917-345-5354
Mailing Address - Street 1:15 RUMSON RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5951
Mailing Address - Country:US
Mailing Address - Phone:917-345-5354
Mailing Address - Fax:
Practice Address - Street 1:15 RUMSON RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5951
Practice Address - Country:US
Practice Address - Phone:917-345-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY478378041252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103K00000XMedicaid