Healthcare Provider Details

I. General information

NPI: 1306319728
Provider Name (Legal Business Name): LAUREN EAVARONE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 E 14TH ST APT 3D
NEW YORK NY
10009-3229
US

IV. Provider business mailing address

45 PIONEER BLVD
HUNTINGTON STATION NY
11746-4423
US

V. Phone/Fax

Practice location:
  • Phone: 631-335-6859
  • Fax:
Mailing address:
  • Phone: 631-335-6859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: