Provider Demographics
NPI:1942653266
Name:ETU, LAUREN (MS CAS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ETU
Suffix:
Gender:F
Credentials:MS CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 UNION RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-5170
Mailing Address - Country:US
Mailing Address - Phone:716-686-3676
Mailing Address - Fax:
Practice Address - Street 1:3550 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5170
Practice Address - Country:US
Practice Address - Phone:716-686-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool