Healthcare Provider Details

I. General information

NPI: 1255101010
Provider Name (Legal Business Name): ELEANOR L LALOR SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10733 WATSON PL
JAMAICA NY
11433-2510
US

IV. Provider business mailing address

10733 WATSON PL
JAMAICA NY
11433-2510
US

V. Phone/Fax

Practice location:
  • Phone: 718-496-6148
  • Fax:
Mailing address:
  • Phone: 718-496-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number071372-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number071372-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number071372-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number071372-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: