MEDICARE: LAUREN VANVELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SL05697300	NJ

General Provider Information

NPI Number	:	1023555356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN VANVELSON

Provider Business Mailing Address
First Line	:	113 MAPLE AVE
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1144
Country	:	US
Telephone Number	:	732-778-8738
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 MAPLE AVE
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1144
Country	:	US
Telephone Number	:	732-778-8738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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