Provider Demographics
NPI:1245627496
Name:DI LAURO, JENNA MARIE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:DI LAURO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S WATER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7226
Mailing Address - Country:US
Mailing Address - Phone:702-983-0434
Mailing Address - Fax:702-906-1844
Practice Address - Street 1:203 S WATER ST STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7226
Practice Address - Country:US
Practice Address - Phone:702-983-0434
Practice Address - Fax:702-906-1844
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NV01455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner