Healthcare Provider Details

I. General information

NPI: 1487631875
Provider Name (Legal Business Name): LAUREN S. CARUSO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 WESTCHESTER AVE SUITE 315
WHITE PLAINS NY
10604-2907
US

IV. Provider business mailing address

215 E 79TH ST SUITE 8A
NEW YORK NY
10021-0847
US

V. Phone/Fax

Practice location:
  • Phone: 212-717-2711
  • Fax: 914-946-1527
Mailing address:
  • Phone: 212-717-2711
  • Fax: 914-946-1527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number012539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: