Provider Demographics
NPI:1801359526
Name:MIZRAHI, LAUREN SHADY
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SHADY
Last Name:MIZRAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:SHADY
Other - Last Name:MIZRAHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11035 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3957
Mailing Address - Country:US
Mailing Address - Phone:347-384-8562
Mailing Address - Fax:
Practice Address - Street 1:20 WENWOOD DR
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-3128
Practice Address - Country:US
Practice Address - Phone:516-723-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst