Provider Demographics
NPI:1144419516
Name:ALTCHILER, LAUREN STAHL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:STAHL
Last Name:ALTCHILER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MONTROSE PL
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3404
Mailing Address - Country:US
Mailing Address - Phone:516-377-2747
Mailing Address - Fax:
Practice Address - Street 1:1955 MERRICK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4642
Practice Address - Country:US
Practice Address - Phone:516-377-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0117131103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical