Provider Demographics
NPI:1124592209
Name:DEMONTE, LAUREN MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:DEMONTE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:POTENZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:18 N RHETT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2259
Mailing Address - Country:US
Mailing Address - Phone:646-346-9003
Mailing Address - Fax:
Practice Address - Street 1:18 N RHETT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2259
Practice Address - Country:US
Practice Address - Phone:646-346-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094548104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker