MEDICARE: LAUREN EMMA LCSW

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

General Provider Information

NPI Number	:	1245796929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN EMMA LCSW

Provider Business Mailing Address
First Line	:	214 CHESTNUT AVE
Second Line	:
City	:	HADDON TOWNSHIP
State	:	NJ
Zip	:	08108-3410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 W MAIN ST STE A
Second Line	:
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2411
Country	:	US
Telephone Number	:	856-779-7386
Fax Number	:	856-779-7563

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

Provider Enumeration Date	:	02/18/2019
Last Update Date	:	12/15/2020

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