Healthcare Provider Details

I. General information

NPI: 1417582529
Provider Name (Legal Business Name): LAUREN MANKUS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 LAGUNA DR APT 4
CARLSBAD CA
92008-1844
US

IV. Provider business mailing address

935 LAGUNA DR APT 4
CARLSBAD CA
92008-1844
US

V. Phone/Fax

Practice location:
  • Phone: 617-830-2621
  • Fax:
Mailing address:
  • Phone: 617-830-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW128349
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW226836
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: