Healthcare Provider Details

I. General information

NPI: 1376465328
Provider Name (Legal Business Name): LAUREN BOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-25 136TH ST
RICHMOND HILL NY
11418-1924
US

IV. Provider business mailing address

8725 136TH ST
RICHMOND HILL NY
11418-1924
US

V. Phone/Fax

Practice location:
  • Phone: 718-291-2807
  • Fax:
Mailing address:
  • Phone: 718-291-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number126858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: