Organization
DBT OF SOUTH JERSEY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAELENE R LAURIANO MA, NCC, LPC (OWNER)
(609) 418-9141
Entity
Organization
Contact information
Practice address
105 EVESBORO MEDFORD RD STE M, MARLTON, NJ 08053-3865
(609) 353-5608
Mailing address
309 MOUNT VERNON AVE, LAUREL SPRINGS, NJ 08021-2034
(609) 418-9141
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770904112
NPPES
NJ
Enumeration date
02/04/2018
Last updated
06/11/2019
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