Provider Demographics
NPI:1194022004
Name:MANCINI, LAURIANN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURIANN
Middle Name:
Last Name:MANCINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAURIANN
Other - Middle Name:
Other - Last Name:CASTROGIOVANNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:28 BROOKSIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-4501
Mailing Address - Country:US
Mailing Address - Phone:917-293-3338
Mailing Address - Fax:
Practice Address - Street 1:28 BROOKSIDE LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-4501
Practice Address - Country:US
Practice Address - Phone:917-293-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical