Healthcare Provider Details

I. General information

NPI: 1407498355
Provider Name (Legal Business Name): LAUREN BOUYEA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N MAIN ST
ATTLEBORO MA
02703-2282
US

IV. Provider business mailing address

71 MESSENGER ST APT 519
PLAINVILLE MA
02762-5056
US

V. Phone/Fax

Practice location:
  • Phone: 508-409-0000
  • Fax:
Mailing address:
  • Phone: 401-580-2086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000225122
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: