Provider Demographics
NPI:1538527775
Name:RENNER, LAURIN V (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LAURIN
Middle Name:V
Last Name:RENNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 42ND ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2726
Mailing Address - Country:US
Mailing Address - Phone:631-335-3202
Mailing Address - Fax:
Practice Address - Street 1:125 42ND ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2726
Practice Address - Country:US
Practice Address - Phone:631-335-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001285-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health