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General NPI Number Information
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NPI Number | 1699207746
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Entity Type | Organization
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Legal Business Name | LAURA MAURIELLO, LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 400 N LA SALLE DR #1507
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City | CHICAGO
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State | IL
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Zip | 60654-8539
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Country | US
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Telephone | 630-890-4899
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Fax | 312-546-7065
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Provider Business Mailing Address
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Address Line | 400 N LA SALLE DR #1507
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City | CHICAGO
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State | IL
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Zip | 60654-8539
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Country | US
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Telephone | 630-890-4899
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Fax | 312-546-7065
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Authorized Official
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Title or Position | OWNER
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Name | LAURA MAURIELLO
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Credential |
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Telephone | 630-890-4899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149017973
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License Number State | IL
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