MEDICARE: LAUREN E VERHEY L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	082165	NY

General Provider Information

NPI Number	:	1255718433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN E VERHEY L.C.S.W.

Provider Business Mailing Address
First Line	:	27 E RALEIGH AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2811
Country	:	US
Telephone Number	:	917-494-6830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3906
Country	:	US
Telephone Number	:	917-494-6830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	04/27/2015

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