Provider Demographics
NPI:1316821127
Name:BERKE, LAUREN COSSEBOOM
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:COSSEBOOM
Last Name:BERKE
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 1:11 STUART CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-1993
Mailing Address - Country:US
Mailing Address - Phone:845-263-0721
Mailing Address - Fax:
Practice Address - Street 1:1443 159TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2720
Practice Address - Country:US
Practice Address - Phone:646-655-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health