Healthcare Provider Details

I. General information

NPI: 1467060269
Provider Name (Legal Business Name): HENRY MICHAEL LABORANTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 STATE STREET
WYALUSING PA
18853
US

IV. Provider business mailing address

312 CHURCH ST
LACEYVILLE PA
18623-6617
US

V. Phone/Fax

Practice location:
  • Phone: 570-871-0143
  • Fax:
Mailing address:
  • Phone: 570-637-3566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025400
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: