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General NPI Number Information
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NPI Number | 1043574353
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Entity Type | Organization
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Legal Business Name | LAURIE MASTRIANNA LLC
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 405 HIGHLAND AVE
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City | WATERBURY
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State | CT
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Zip | 06708-3419
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Country | US
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Telephone | 203-228-9332
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Fax |
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Provider Business Mailing Address
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Address Line | 286 JERSEY ST
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City | WATERBURY
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State | CT
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Zip | 06706-2717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED SOCIAL WORKER
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Name | MRS. LAURIE MASTRIANNA
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Credential | LCSW
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Telephone | 203-228-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 007687
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License Number State | CT
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