Provider Demographics
NPI:1538806138
Name:FASANO, LAUREN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:FASANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HINGLE PL
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1845
Mailing Address - Country:US
Mailing Address - Phone:631-339-3096
Mailing Address - Fax:
Practice Address - Street 1:3 HINGLE PL
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1845
Practice Address - Country:US
Practice Address - Phone:631-339-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102847-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker