Provider Demographics
NPI:1083057772
Name:KLIMEK, LAUREN ANNE (MT-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:KLIMEK
Suffix:
Gender:F
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 E ROGUES PATH
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2738
Mailing Address - Country:US
Mailing Address - Phone:631-245-0275
Mailing Address - Fax:631-421-5393
Practice Address - Street 1:75 E ROGUES PATH
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2738
Practice Address - Country:US
Practice Address - Phone:631-245-0275
Practice Address - Fax:631-421-5393
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001618221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00001618Medicaid