Provider Demographics
NPI:1972148997
Name:DILAURENZIO, JOSEPH MATTHEW (LMHC,LPC, NCC,CASAC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:DILAURENZIO
Suffix:
Gender:M
Credentials:LMHC,LPC, NCC,CASAC
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:M
Other - Last Name:DILAURENZIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, LPC, NCC,CASAC
Mailing Address - Street 1:40 CROSS RD APT 99
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1109
Mailing Address - Country:US
Mailing Address - Phone:631-882-4298
Mailing Address - Fax:
Practice Address - Street 1:426 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1431
Practice Address - Country:US
Practice Address - Phone:516-341-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35491101YA0400X
NY011922101YM0800X
NJ37PC00819300101YP2500X
1095059101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional