Healthcare Provider Details

I. General information

NPI: 1114534740
Provider Name (Legal Business Name): LAUREN ELIZABETH DEVITO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE
ROCKVILLE CENTRE NY
11570-3761
US

IV. Provider business mailing address

327 RIVIERA PKWY
LINDENHURST NY
11757-6322
US

V. Phone/Fax

Practice location:
  • Phone: 516-594-0247
  • Fax:
Mailing address:
  • Phone: 516-312-2533
  • Fax: 516-493-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088010
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: