Healthcare Provider Details

I. General information

NPI: 1114413382
Provider Name (Legal Business Name): LAUREN BRONZO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW STE 400
WASHINGTON DC
20015-2055
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW STE 400
WASHINGTON DC
20015-2055
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-1010
  • Fax:
Mailing address:
  • Phone: 202-363-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number200001243
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: