Provider Demographics
NPI:1306319728
Name:EAVARONE, LAUREN (LMFT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:EAVARONE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4423
Mailing Address - Country:US
Mailing Address - Phone:631-335-6859
Mailing Address - Fax:
Practice Address - Street 1:635 E 14TH ST APT 3D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3229
Practice Address - Country:US
Practice Address - Phone:631-335-6859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist