Healthcare Provider Details

I. General information

NPI: 1841073327
Provider Name (Legal Business Name): LAUREN QUAST ESPOSITO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN FERN QUAST

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

1467 MONROE DR NE APT 15
ATLANTA GA
30324-5325
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-6400
  • Fax:
Mailing address:
  • Phone: 703-424-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY004723
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: