Provider Demographics
NPI:1609082452
Name:TOBING-PUENTE, LAUREN E (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:TOBING-PUENTE
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 1:525 E 12TH ST
Mailing Address - Street 2:#CF
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3950
Mailing Address - Country:US
Mailing Address - Phone:917-838-9274
Mailing Address - Fax:
Practice Address - Street 1:525 E 12TH ST
Practice Address - Street 2:#CF
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3950
Practice Address - Country:US
Practice Address - Phone:917-838-9274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016789103TC2200X, 103TM1800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical