Provider Demographics
NPI:1699438333
Name:BOLLACI, LAUREN (ATR-BC, LCAT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:BOLLACI
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1924
Mailing Address - Country:US
Mailing Address - Phone:516-996-1843
Mailing Address - Fax:
Practice Address - Street 1:11 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1924
Practice Address - Country:US
Practice Address - Phone:516-996-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002185221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist