Provider Demographics
NPI:1538594536
Name:MAURIELLO, LAURA KATE
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KATE
Last Name:MAURIELLO
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 1:400 N LA SALLE DR
Mailing Address - Street 2:#1507
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8539
Mailing Address - Country:US
Mailing Address - Phone:630-890-4899
Mailing Address - Fax:312-546-7065
Practice Address - Street 1:2043 W. BELMONT AVE.
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6796
Practice Address - Country:US
Practice Address - Phone:773-332-9439
Practice Address - Fax:773-348-2073
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490179731041C0700X
222Q00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist