Provider Demographics
NPI:1740531664
Name:JULIANO, LAUREL JENINE (LCADC, LAC)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:JENINE
Last Name:JULIANO
Suffix:
Gender:F
Credentials:LCADC, LAC
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:DE LUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4611
Mailing Address - Country:US
Mailing Address - Phone:732-920-2700
Mailing Address - Fax:
Practice Address - Street 1:340 ATLANTIC CITY BOULEVARD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721
Practice Address - Country:US
Practice Address - Phone:848-224-4897
Practice Address - Fax:848-224-4826
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00612800101YM0800X
NJ37LC00187900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health