Healthcare Provider Details

I. General information

NPI: 1124640966
Provider Name (Legal Business Name): LAUREN KRANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FLATBUSH AVE
BROOKLYN NY
11217-2812
US

IV. Provider business mailing address

122 PARK PL
BROOKLYN NY
11217-3303
US

V. Phone/Fax

Practice location:
  • Phone: 718-622-2000
  • Fax: 718-398-3328
Mailing address:
  • Phone: 201-213-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number086219-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: