Healthcare Provider Details

I. General information

NPI: 1013842996
Provider Name (Legal Business Name): LAUREN GOETZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MADISON AVE RM 210
NEW YORK NY
10016-0816
US

IV. Provider business mailing address

249 AINSLIE ST APT 2B
BROOKLYN NY
11211-5118
US

V. Phone/Fax

Practice location:
  • Phone: 415-272-7655
  • Fax:
Mailing address:
  • Phone: 415-272-7655
  • 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: