Provider Demographics
NPI:1952451189
Name:LAURENZANO, CAROL B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:B
Last Name:LAURENZANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N OTT ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4834
Mailing Address - Country:US
Mailing Address - Phone:484-224-2216
Mailing Address - Fax:484-224-2216
Practice Address - Street 1:415 N OTT ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4834
Practice Address - Country:US
Practice Address - Phone:484-224-2216
Practice Address - Fax:484-224-2216
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005827-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA666686Medicare ID - Type UnspecifiedBLUE SHIELD