Healthcare Provider Details

I. General information

NPI: 1407616055
Provider Name (Legal Business Name): LAUREN CANTOR MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 SW FEDERAL HWY STE 203
STUART FL
34994-2972
US

IV. Provider business mailing address

5163 N HIGHWAY A1A APT 417
HUTCHINSON ISLAND FL
34949-8218
US

V. Phone/Fax

Practice location:
  • Phone: 772-281-0599
  • Fax:
Mailing address:
  • Phone: 330-806-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH25581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: