Provider Demographics
NPI:1699174912
Name:MCDONOUGH, LAUREN ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 BROADWAY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9502
Mailing Address - Country:US
Mailing Address - Phone:212-443-9999
Mailing Address - Fax:212-443-1223
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9502
Practice Address - Country:US
Practice Address - Phone:212-443-9999
Practice Address - Fax:212-443-1223
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720915271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical