Provider Demographics
NPI:1831349125
Name:PETROCELLI, LAUREN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:PETROCELLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:LAMONOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 FAIRCHILD PL APT 1
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2737
Mailing Address - Country:US
Mailing Address - Phone:914-400-5093
Mailing Address - Fax:
Practice Address - Street 1:102 FAIRCHILD PL APT 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2737
Practice Address - Country:US
Practice Address - Phone:914-400-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13684168-35011041C0700X
MO20240032541041C0700X
NY0920821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical