Provider Demographics
NPI:1093898462
Name:LAUREN S. CARUSO PHD, PSYCHOLOGIST, PC
Entity Type:Organization
Organization Name:LAUREN S. CARUSO PHD, PSYCHOLOGIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-717-2711
Mailing Address - Street 1:215 E 79TH ST
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-717-2711
Mailing Address - Fax:914-946-1527
Practice Address - Street 1:321 EAST 48TH STREET
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-717-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12539103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV05321Medicare ID - Type Unspecified