1730427162 NPI number — LAURISSA LYNN MALLOZZI HAMPTON

Table of content: LAURISSA LYNN MALLOZZI HAMPTON (NPI 1730427162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730427162 NPI number — LAURISSA LYNN MALLOZZI HAMPTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMPTON
Provider First Name:
LAURISSA
Provider Middle Name:
LYNN MALLOZZI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALLOZZI
Provider Other First Name:
LAURISSA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC CASAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730427162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 ATLANTIC AVE
Provider Second Line Business Mailing Address:
3RD FL
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11213-1122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1545 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
3RD FL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-613-3232
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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