Provider Demographics
NPI:1871870501
Name:NELSON, LAUREN (LMSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FIRE ROAD DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3947
Mailing Address - Country:US
Mailing Address - Phone:631-666-1951
Mailing Address - Fax:888-515-1420
Practice Address - Street 1:250 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8337
Practice Address - Country:US
Practice Address - Phone:631-666-1951
Practice Address - Fax:888-515-1420
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074014104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker