Healthcare Provider Details

I. General information

NPI: 1346502424
Provider Name (Legal Business Name): LAUREN VARRICCHIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 02/17/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 GOSHEN TPKE
MIDDLETOWN NY
10941-4031
US

IV. Provider business mailing address

824 BAY SHORE AVE
WEST ISLIP NY
11795-1538
US

V. Phone/Fax

Practice location:
  • Phone: 845-360-5744
  • Fax:
Mailing address:
  • Phone: 516-835-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number484070101
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-51739
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: