1770065971 NPI number — MRS. LAUREN STACIE MCCABE LCSW

Table of content: MRS. LAUREN STACIE MCCABE LCSW (NPI 1770065971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770065971 NPI number — MRS. LAUREN STACIE MCCABE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCABE
Provider First Name:
LAUREN
Provider Middle Name:
STACIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCABE
Provider Other First Name:
LAUREN
Provider Other Middle Name:
STACIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770065971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 OAKFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11520-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-654-4715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
496 SMITHTOWN BYP STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11787-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-654-4715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/04/2018

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: 1041C0700X , with the licence number:  086233 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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