1033639257 NPI number — LAUREN A. FURY LCSW

Table of content: (NPI 1033639257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033639257 NPI number — LAUREN A. FURY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREN A. FURY LCSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033639257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 PINEWOOD AVE FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12208-2718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-577-9954
Provider Business Mailing Address Fax Number:
518-252-3499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
834 KENWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLINGERLANDS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12159-9621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-577-9954
Provider Business Practice Location Address Fax Number:
518-252-3499
Provider Enumeration Date:
06/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FURY
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
LCSW/SOLE PROPRIETOR
Authorized Official Telephone Number:
518-577-9954

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  083347 , 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)

  • Identifier: 04242260 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: NGH171 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126725363183 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200318055001 . This is a "CAPITAL DISTRICT PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 842806 . This is a "BEACON HEALTH OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NGH171 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1537819P . This is a "EMBLEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 566535 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: N96R71 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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