Provider Demographics
NPI:1306081450
Name:CERULLO DENIS, LAURA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:CERULLO DENIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 FIRE HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3532
Mailing Address - Country:US
Mailing Address - Phone:203-438-2230
Mailing Address - Fax:
Practice Address - Street 1:122 FIRE HILL RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3532
Practice Address - Country:US
Practice Address - Phone:203-438-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005397-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker