Provider Demographics
NPI:1871057166
Name:FASANELLA, LAUREN LANGFORD (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LANGFORD
Last Name:FASANELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:LANGFORD
Other - Last Name:FASANELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:520 E 72ND ST APT 12K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5198
Mailing Address - Country:US
Mailing Address - Phone:617-842-8676
Mailing Address - Fax:
Practice Address - Street 1:525 EAST 71 STREET
Practice Address - Street 2:BELAIRE 5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1002
Practice Address - Country:US
Practice Address - Phone:917-260-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0785111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical