Provider Demographics
NPI:1033781703
Name:TANTILLO, LAUREN CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CHRISTINE
Last Name:TANTILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 CHILI AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3334
Mailing Address - Country:US
Mailing Address - Phone:585-402-3207
Mailing Address - Fax:
Practice Address - Street 1:2510 CHILI AVE STE 6
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3334
Practice Address - Country:US
Practice Address - Phone:585-402-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0960871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty