Healthcare Provider Details

I. General information

NPI: 1952077034
Provider Name (Legal Business Name): LAUREN RENAE LAQUE LSCW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 RITCHIE HWY STE 200
SEVERNA PARK MD
21146-3935
US

IV. Provider business mailing address

650 RITCHIE HWY STE 200
SEVERNA PARK MD
21146-3935
US

V. Phone/Fax

Practice location:
  • Phone: 410-834-8394
  • Fax: 443-572-4963
Mailing address:
  • Phone: 410-834-8394
  • Fax: 443-572-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30205
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: