Provider Demographics
NPI:1194034629
Name:NOLL, LAUREN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:D
Last Name:NOLL
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 1:250 BALTIC STREET, 2ND FLOOR
Mailing Address - Street 2:BALTIC STREET CLINIC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-855-3131
Mailing Address - Fax:
Practice Address - Street 1:250 BALTIC ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6401
Practice Address - Country:US
Practice Address - Phone:718-855-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical