Provider Demographics
NPI:1770904112
Name:LAURIANO, SHAELENE RAE (LAC, NCC)
Entity type:Individual
Prefix:
First Name:SHAELENE
Middle Name:RAE
Last Name:LAURIANO
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EVESBORO MEDFORD RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3865
Mailing Address - Country:US
Mailing Address - Phone:609-353-5608
Mailing Address - Fax:
Practice Address - Street 1:105 EVESBORO MEDFORD RD
Practice Address - Street 2:SUITE M
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3865
Practice Address - Country:US
Practice Address - Phone:609-353-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00135500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health