Provider Demographics
NPI:1114515301
Name:DORMAN, LAUREN TETENBAUM (LCSW, JD, PMH-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:TETENBAUM
Last Name:DORMAN
Suffix:
Gender:F
Credentials:LCSW, JD, PMH-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:A
Other - Last Name:TETENBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:14 INNES RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7110
Mailing Address - Country:US
Mailing Address - Phone:917-301-0184
Mailing Address - Fax:
Practice Address - Street 1:14 HARWOOD CT STE 512
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4120
Practice Address - Country:US
Practice Address - Phone:917-301-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0974771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical