MEDICARE: LAUREN ATLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1811372550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ATLAS

Provider Business Mailing Address
First Line	:	142 JORALEMON ST
Second Line	:	SUITE 3E
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4747
Country	:	US
Telephone Number	:	718-935-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2098 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10026-2792
Country	:	US
Telephone Number	:	912-663-6224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	07/23/2015

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Directions to “ LAUREN ATLAS ” Practice Location

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