Provider Demographics
NPI:1154587715
Name:SIMONELLI, LAURA E (PHD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:SIMONELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 GRAYSON LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-2104
Mailing Address - Country:US
Mailing Address - Phone:302-415-5434
Mailing Address - Fax:
Practice Address - Street 1:173 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2514
Practice Address - Country:US
Practice Address - Phone:267-890-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB10000792103TC0700X
PAPS017738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical