Healthcare Provider Details

I. General information

NPI: 1740881663
Provider Name (Legal Business Name): LAUREN AMIGO LCAT, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 05/15/2024
Certification Date: 02/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE 4242
ALBANY NY
12207-2922
US

IV. Provider business mailing address

418 BROADWAY STE 4242
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 917-818-2466
  • Fax:
Mailing address:
  • Phone: 917-818-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23052
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: