Provider Demographics
NPI:1578642021
Name:GREENWALD FROITZHEIM, LAUREN STACEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:STACEY
Last Name:GREENWALD FROITZHEIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:STACEY
Other - Last Name:GREENWALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:22 30 RAILROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782
Mailing Address - Country:US
Mailing Address - Phone:631-218-1960
Mailing Address - Fax:
Practice Address - Street 1:22 30 RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782
Practice Address - Country:US
Practice Address - Phone:631-218-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL45216104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNE1981Medicare ID - Type Unspecified