Healthcare Provider Details

I. General information

NPI: 1669031167
Provider Name (Legal Business Name): LAUREN ELIZABETH PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOSTON AVE STE 1925
MEDFORD MA
02155-4243
US

IV. Provider business mailing address

173 MADISON ST APT 2
FITCHBURG MA
01420-5022
US

V. Phone/Fax

Practice location:
  • Phone: 781-628-2106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY5000138
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: