Provider Demographics
NPI:1487704672
Name:LAURICELLA, SHAUNA KATHLEEN (PHD)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:KATHLEEN
Last Name:LAURICELLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:KATHLEEN
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:177 MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6917
Mailing Address - Country:US
Mailing Address - Phone:631-629-5283
Mailing Address - Fax:
Practice Address - Street 1:177 MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6917
Practice Address - Country:US
Practice Address - Phone:631-629-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018604-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical