Provider Demographics
NPI:1972958320
Name:DERUVO, LAUREN PATRICIA (SLP)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:PATRICIA
Last Name:DERUVO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:PATRICIA
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:224 ABBEY ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3549
Mailing Address - Country:US
Mailing Address - Phone:516-652-1521
Mailing Address - Fax:
Practice Address - Street 1:55 LINDNER PL
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1408
Practice Address - Country:US
Practice Address - Phone:646-951-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026632235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist