=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003570177
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN SAMMIS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2021
-----------------------------------------------------
Last Update Date | 10/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1777 VETERANS MEMORIAL HWY
-----------------------------------------------------
City | ISLANDIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11749-1555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-630-6439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 GILBERT ST
-----------------------------------------------------
City | PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-3641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-255-7300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 114345
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------