Provider Demographics
NPI:1093204760
Name:ALZATE, LAUREN CAROLINA
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:CAROLINA
Last Name:ALZATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:CAROLINA
Other - Last Name:SALAZAR LERMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAUREN ALZATE
Mailing Address - Street 1:2815 COYLE ST APT 303
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1739
Mailing Address - Country:US
Mailing Address - Phone:929-404-8795
Mailing Address - Fax:
Practice Address - Street 1:2815 COYLE ST APT 303
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1739
Practice Address - Country:US
Practice Address - Phone:929-404-8795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY900B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator