Healthcare Provider Details

I. General information

NPI: 1356265094
Provider Name (Legal Business Name): LAUREN MEREDITH DA COSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN MEREDITH PETERS

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 3RD ST STE 5
JAMESTOWN NY
14701-5433
US

IV. Provider business mailing address

2 ACADEMY ST RM 201
MAYVILLE NY
14757-1050
US

V. Phone/Fax

Practice location:
  • Phone: 716-661-8330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: