Provider Demographics
NPI:1760211650
Name:LAUREN TETENBAUM DORMAN LCSW PLLC
Entity type:Organization
Organization Name:LAUREN TETENBAUM DORMAN LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:TETENBAUM
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, JD, PMH-C
Authorized Official - Phone:917-301-0184
Mailing Address - Street 1:14 INNES RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7110
Mailing Address - Country:US
Mailing Address - Phone:917-301-0184
Mailing Address - Fax:
Practice Address - Street 1:14 HARWOOD CT STE 512
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4120
Practice Address - Country:US
Practice Address - Phone:914-721-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty