Healthcare Provider Details

I. General information

NPI: 1336287879
Provider Name (Legal Business Name): LAUREN C. CARAVELLA PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COURTHOUSE SQ SUITE 202
ROCKVILLE MD
20850-2336
US

IV. Provider business mailing address

20 COURTHOUSE SQ SUITE 202
ROCKVILLE MD
20850-2336
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-6955
  • Fax: 301-424-4836
Mailing address:
  • Phone: 301-424-6955
  • Fax: 301-424-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04097
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: