Healthcare Provider Details

I. General information

NPI: 1104545367
Provider Name (Legal Business Name): LAURYN ANN MACEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OSBORN ST
FALL RIVER MA
02724-2814
US

IV. Provider business mailing address

8 PAUL DR
WESTPORT MA
02790-3457
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-5708
  • Fax:
Mailing address:
  • Phone: 508-264-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: