Healthcare Provider Details

I. General information

NPI: 1063755296
Provider Name (Legal Business Name): EMILY A LAURENZANO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2013
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SILVER ST
MIDDLETOWN CT
06457-3946
US

IV. Provider business mailing address

400 BURR ST UNIT 8
NEW HAVEN CT
06512-3669
US

V. Phone/Fax

Practice location:
  • Phone: 877-577-3233
  • Fax:
Mailing address:
  • Phone: 413-537-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number270307
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70311
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: