Provider Demographics
NPI:1861917650
Name:DRAGO, LAUREN LARUSSO (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LARUSSO
Last Name:DRAGO
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2451
Mailing Address - Country:US
Mailing Address - Phone:773-569-5422
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2365
Practice Address - Country:US
Practice Address - Phone:914-288-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006885-1101YM0800X
PAPC007060101YM0800X
CT002719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health