1992178917 NPI number — MRS. LAUREN ASHLEY RICHARD HOLT LCSW

Table of content: MRS. LAUREN ASHLEY RICHARD HOLT LCSW (NPI 1992178917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992178917 NPI number — MRS. LAUREN ASHLEY RICHARD HOLT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARD HOLT
Provider First Name:
LAUREN
Provider Middle Name:
ASHLEY
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:
RICHARD
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992178917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 THOMAS LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
E.SETAUKET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11733-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-375-1865
Provider Business Mailing Address Fax Number:
631-909-3558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER MORICHES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11934-3518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-874-0185
Provider Business Practice Location Address Fax Number:
631-909-3558
Provider Enumeration Date:
11/12/2015

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: 104100000X , with the licence number:  088456-1 , 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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