Healthcare Provider Details

I. General information

NPI: 1225319734
Provider Name (Legal Business Name): LAUREN CHAMELEON CAMIOLO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367 2ND AVE
NEW YORK NY
10035-3108
US

IV. Provider business mailing address

2367-69 SECOND AVENUE
NEW YORK NY
10035
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax:
Mailing address:
  • Phone: 212-876-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0842231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: