Provider Demographics
NPI:1528570397
Name:HAYTHE, LAUREN (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HAYTHE
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CLINTON AVE APT 10H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1160
Mailing Address - Country:US
Mailing Address - Phone:917-861-4188
Mailing Address - Fax:
Practice Address - Street 1:481 BROADWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:917-861-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026418-1225700000X
NY006029-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist