MEDICARE: STACEY A DELAURA LIC. AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	590	MA
2	101YP2500X	Professional Counselor	8705	CT

General Provider Information

NPI Number	:	1518127257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY A DELAURA LIC. AC.

Provider Business Mailing Address
First Line	:	81 CHARTER OAK DR
Second Line	:
City	:	EAST LYME
State	:	CT
Zip	:	06333-1619
Country	:	US
Telephone Number	:	860-888-9861
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 CHARTER OAK DR
Second Line	:
City	:	EAST LYME
State	:	CT
Zip	:	06333-1619
Country	:	US
Telephone Number	:	860-888-9861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/03/2026

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