=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215172986
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN P MCEVOY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2008
-----------------------------------------------------
Last Update Date | 08/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79 ROKEBY RD
-----------------------------------------------------
City | RED HOOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12571-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-241-0585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 ROKEBY RD
-----------------------------------------------------
City | RED HOOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12571-1917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-241-0585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 080460
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 117851
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------