Healthcare Provider Details

I. General information

NPI: 1790615086
Provider Name (Legal Business Name): DR. LAUREN R BROUSSARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 REED ST NE APT 521
WASHINGTON DC
20018-1809
US

IV. Provider business mailing address

2607 REED ST NE APT 521
WASHINGTON DC
20018-1809
US

V. Phone/Fax

Practice location:
  • Phone: 202-725-8948
  • Fax:
Mailing address:
  • Phone: 202-725-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34675
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG2000004413
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: