Healthcare Provider Details

I. General information

NPI: 1811674799
Provider Name (Legal Business Name): LAUREN MAXWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 LAFAYETTE ST
NEW BRITAIN CT
06051-1803
US

IV. Provider business mailing address

19 GRAND ST
MIDDLETOWN CT
06457-2705
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-3642
  • Fax: 860-224-2760
Mailing address:
  • Phone: 860-347-6971
  • Fax: 860-343-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16674
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: