Healthcare Provider Details

I. General information

NPI: 1710719877
Provider Name (Legal Business Name): DIANA LAUREANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 LIBERTY ST
SPRINGFIELD MA
01104-3779
US

IV. Provider business mailing address

112 QUAKER RD
SPRINGFIELD MA
01118-1434
US

V. Phone/Fax

Practice location:
  • Phone: 413-301-9355
  • Fax:
Mailing address:
  • Phone: 407-427-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: