Provider Demographics
NPI:1861213589
Name:MATHEW, LAURENA MARIAM
Entity type:Individual
Prefix:
First Name:LAURENA
Middle Name:MARIAM
Last Name:MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-4211
Mailing Address - Country:US
Mailing Address - Phone:845-570-7262
Mailing Address - Fax:
Practice Address - Street 1:27 DORCHESTER DR
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-4211
Practice Address - Country:US
Practice Address - Phone:845-570-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070037001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical