Provider Demographics
NPI:1497187736
Name:DECAPORALE-RYAN, LAUREN N (PHD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:N
Last Name:DECAPORALE-RYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:N
Other - Last Name:DECAPORALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX PSYCH
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-279-4858
Mailing Address - Fax:585-442-8319
Practice Address - Street 1:300 CRITTENDEN BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-279-4858
Practice Address - Fax:585-442-8319
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19809103T00000X
NY019809-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist