Healthcare Provider Details

I. General information

NPI: 1629403449
Provider Name (Legal Business Name): LAUREN GRAY MCCARTHA SERKIS MSCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3058 SAN JOSE VINEYARD CT UNIT 3
SAN JOSE CA
95136-4982
US

IV. Provider business mailing address

3058 SAN JOSE VINEYARD CT UNIT 3
SAN JOSE CA
95136-4982
US

V. Phone/Fax

Practice location:
  • Phone: 408-337-6868
  • Fax:
Mailing address:
  • Phone: 408-337-6868
  • Fax: 808-848-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: