MEDICARE: LAUREN BARDACH

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	104100000X	Social Worker	44SL05978200	NJ

General Provider Information

NPI Number	:	1346642295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BARDACH

Provider Business Mailing Address
First Line	:	2 CHANGEBRIDGE RD
Second Line	:	SUITE 203
City	:	MONTVILLE
State	:	NJ
Zip	:	07045-8947
Country	:	US
Telephone Number	:	973-263-0683
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 MAIN RD
Second Line	:
City	:	MONTVILLE
State	:	NJ
Zip	:	07045-9785
Country	:	US
Telephone Number	:	973-316-9333
Fax Number	:

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

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	02/23/2015

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Directions to “ LAUREN BARDACH ” Practice Location

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