Healthcare Provider Details

I. General information

NPI: 1871101949
Provider Name (Legal Business Name): LAUREN JUKOFSKY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3678 OCEANSIDE RD W STE 102
OCEANSIDE NY
11572-5981
US

IV. Provider business mailing address

3678 OCEANSIDE RD W STE 102
OCEANSIDE NY
11572-5981
US

V. Phone/Fax

Practice location:
  • Phone: 516-986-7030
  • Fax:
Mailing address:
  • Phone: 516-986-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number081142-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: