Provider Demographics
NPI:1689939514
Name:PETERSON, LAUREN B (EDM)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:PETERSON
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CLOVER DR
Mailing Address - Street 2:PUPIL PERSONNEL SERVICES, GREAT NECK PUBLIC SCHOOLS
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1031
Mailing Address - Country:US
Mailing Address - Phone:516-441-4970
Mailing Address - Fax:516-441-4270
Practice Address - Street 1:105 CLOVER DR
Practice Address - Street 2:PUPIL PERSONNEL SERVICES, GREAT NECK PUBLIC SCHOOLS
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1031
Practice Address - Country:US
Practice Address - Phone:516-441-4970
Practice Address - Fax:516-441-4270
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool