Provider Demographics
NPI:1992541726
Name:SQUILLACE, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SQUILLACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WARREN PL
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1933
Mailing Address - Country:US
Mailing Address - Phone:917-744-7905
Mailing Address - Fax:
Practice Address - Street 1:14 WARREN PL
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1933
Practice Address - Country:US
Practice Address - Phone:917-744-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management