MEDICARE: JENNA MARIE DI LAURO M.S., LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	106H00000X	Marriage & Family Therapist	01455	NV

General Provider Information

NPI Number	:	1245627496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MARIE DI LAURO M.S., LMFT

Provider Business Mailing Address
First Line	:	203 S WATER ST STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-7226
Country	:	US
Telephone Number	:	702-983-0434
Fax Number	:	702-906-1844

Provider Business Practice Location Address
First Line	:	203 S WATER ST STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-7226
Country	:	US
Telephone Number	:	702-983-0434
Fax Number	:	702-906-1844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	03/26/2019

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