Provider Demographics
NPI:1316208440
Name:SCANLON, LAUREN MARIE
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:SCANLON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:CIACCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3548 BUNKER AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3439
Mailing Address - Country:US
Mailing Address - Phone:516-236-3992
Mailing Address - Fax:
Practice Address - Street 1:3548 BUNKER AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3439
Practice Address - Country:US
Practice Address - Phone:516-236-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY585153111174400000X
NY327840091174400000X
NY626902121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist