Provider Demographics
NPI:1992178917
Name:RICHARD HOLT, LAUREN ASHLEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:RICHARD HOLT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ASHLEY
Other - Last Name:RICHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:38 THOMAS LANE
Mailing Address - Street 2:
Mailing Address - City:E.SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-0001
Mailing Address - Country:US
Mailing Address - Phone:631-375-1865
Mailing Address - Fax:631-909-3558
Practice Address - Street 1:408 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3518
Practice Address - Country:US
Practice Address - Phone:631-874-0185
Practice Address - Fax:631-909-3558
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088456-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker