Provider Demographics
NPI:1679003552
Name:ELCHONEN, LAUREN JENNIFER (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:JENNIFER
Last Name:ELCHONEN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:ALTABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3134
Mailing Address - Country:US
Mailing Address - Phone:845-659-7008
Mailing Address - Fax:
Practice Address - Street 1:21 VINCENT ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3134
Practice Address - Country:US
Practice Address - Phone:845-659-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27130582080P0006X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics