Provider Demographics
NPI:1902320138
Name:MAINELLI, LAURA ELIZABETH (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:MAINELLI
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2304
Mailing Address - Country:US
Mailing Address - Phone:860-402-3399
Mailing Address - Fax:
Practice Address - Street 1:31 BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2304
Practice Address - Country:US
Practice Address - Phone:203-234-1324
Practice Address - Fax:203-234-1611
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000634237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000634OtherSTATE OF CT LICENSE