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Individual
LAUREN DEROSA
Active
Individual
LAUREN DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
084318
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID PROVIDER ID
NY
01
—
1285628552
AGENCY NPI #
NY
01
—
WVE061
AGENCY MEDICARE ID
NY
Enumeration date
09/21/2009
Last updated
08/18/2011
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