Provider Demographics
NPI:1184233975
Name:BRADY, LAURYN S (LCSW)
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:S
Last Name:BRADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 UNDERHILL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3432
Mailing Address - Country:US
Mailing Address - Phone:516-642-6744
Mailing Address - Fax:
Practice Address - Street 1:575 UNDERHILL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3432
Practice Address - Country:US
Practice Address - Phone:516-642-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089191-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical