MEDICARE: LAUREN DELAPARTE PHD

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	103TC0700X	Clinical Psychologist	PSY0005320	CO
2	103TC0700X	Clinical Psychologist	PY11506	FL

General Provider Information

NPI Number	:	1730713868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DELAPARTE PHD

Provider Business Mailing Address
First Line	:	11250 OLD SAINT AUGUSTINE RD STE 15-150
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11250 OLD SAINT AUGUSTINE RD STE 15-150
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:	904-201-9565
Fax Number	:

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	10/05/2022

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