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NPI Code Detail

MEDICARE: LAURA KATE MAURIELLO

MEDICARE: LAURA KATE MAURIELLO
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
11041C0700XClinical Social Worker149017973IL
2222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1538594536
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA KATE MAURIELLO
Provider Business Mailing Address
First Line : 400 N LA SALLE DR
Second Line : #1507
City : CHICAGO
State : IL
Zip : 60654-8539
Country : US
Telephone Number : 630-890-4899
Fax Number : 312-546-7065
Provider Business Practice Location Address
First Line : 2043 W. BELMONT AVE.
Second Line : UNIT 1
City : CHICAGO
State : IL
Zip : 60618-6796
Country : US
Telephone Number : 773-332-9439
Fax Number : 773-348-2073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2013
Last Update Date : 02/13/2017

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Directions to “ LAURA KATE MAURIELLO ” Practice Location

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