MEDICARE: LAUREN MICHELE LANZA 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	66207	TX

General Provider Information

NPI Number	:	1952069155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MICHELE LANZA LCSW

Provider Business Mailing Address
First Line	:	4621 ACUSHNET DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2108
Country	:	US
Telephone Number	:	206-512-6113
Fax Number	:

Provider Business Practice Location Address
First Line	:	6629 WOOLDRIDGE RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-2909
Country	:	US
Telephone Number	:	361-986-8200
Fax Number	:

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

Provider Enumeration Date	:	12/04/2021
Last Update Date	:	12/04/2021

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