Healthcare Provider Details

I. General information

NPI: 1558847012
Provider Name (Legal Business Name): LAUREN ALEXIS RACHEL CORRELL PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN RACHEL CORRELL

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE PSYCHOLOGY SERVICE (116B)
PALO ALTO CA
94304
US

IV. Provider business mailing address

1 VISTA MONTANA APT 4306
SAN JOSE CA
95134-2734
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 215-776-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: