Provider Demographics
NPI:1033920814
Name:MOHRAN, LAIREN BALDEVARONA (LMT)
Entity type:Individual
Prefix:
First Name:LAIREN
Middle Name:BALDEVARONA
Last Name:MOHRAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 35TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1552
Mailing Address - Country:US
Mailing Address - Phone:347-605-6457
Mailing Address - Fax:
Practice Address - Street 1:3616 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-1046
Practice Address - Country:US
Practice Address - Phone:631-871-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist