Provider Demographics
NPI:1245317320
Name:AGAZARIAN, LAUREN ELYSE (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELYSE
Last Name:AGAZARIAN
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 1:7235 112TH ST
Mailing Address - Street 2:APT. 8C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5469
Mailing Address - Country:US
Mailing Address - Phone:718-268-4618
Mailing Address - Fax:
Practice Address - Street 1:386 PARK AVE S
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8804
Practice Address - Country:US
Practice Address - Phone:212-481-2500
Practice Address - Fax:212-481-8157
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072006-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical