Healthcare Provider Details

I. General information

NPI: 1386235968
Provider Name (Legal Business Name): LAUREN JOY BORDER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18444 N 25TH AVE STE 420
PHOENIX AZ
85023-1268
US

IV. Provider business mailing address

19918 N 42ND LN
GLENDALE AZ
85308-2293
US

V. Phone/Fax

Practice location:
  • Phone: 623-203-3407
  • Fax:
Mailing address:
  • Phone: 623-203-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-16207
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW22115
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: