Provider Demographics
NPI:1972038164
Name:ROGERS-SIRIN, LAUREN (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:ROGERS-SIRIN
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 1:401 BLOOMINGDALE RD
Mailing Address - Street 2:STE 5
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2010
Mailing Address - Country:US
Mailing Address - Phone:718-948-7800
Mailing Address - Fax:718-948-1733
Practice Address - Street 1:401 BLOOMINGDALE RD
Practice Address - Street 2:STE 5
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2010
Practice Address - Country:US
Practice Address - Phone:718-948-7800
Practice Address - Fax:718-948-1733
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018630103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical