MEDICARE: LAUREN HUNTER LCSW

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	104100000X	Social Worker	107641	NY
2	1041C0700X	Clinical Social Worker	223875	MA
3	1041C0700X	Clinical Social Worker	093771	NY

General Provider Information

NPI Number	:	1346718822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN HUNTER LCSW

Provider Business Mailing Address
First Line	:	217 W BROADWAY UNIT 321
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-1356
Country	:	US
Telephone Number	:	631-560-0914
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 W BROADWAY UNIT 321
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-1356
Country	:	US
Telephone Number	:	631-560-0914
Fax Number	:

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

Provider Enumeration Date	:	11/02/2018
Last Update Date	:	07/11/2022

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