Provider Demographics
NPI:1548522162
Name:LAMICELLA, GINA (MS SPED)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:LAMICELLA
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:LAMICELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSPED
Mailing Address - Street 1:952 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-4336
Mailing Address - Country:US
Mailing Address - Phone:917-345-5354
Mailing Address - Fax:
Practice Address - Street 1:952 46TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-4336
Practice Address - Country:US
Practice Address - Phone:917-345-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1548522162Medicaid
FL1548522162Medicaid