Healthcare Provider Details

I. General information

NPI: 1770153355
Provider Name (Legal Business Name): LAUREN SIMICICH LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 10/14/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ROUTE 526
ALLENTOWN NJ
08501-2015
US

IV. Provider business mailing address

112 ROUTE 526
ALLENTOWN NJ
08501-2015
US

V. Phone/Fax

Practice location:
  • Phone: 732-512-8766
  • Fax:
Mailing address:
  • Phone: 732-512-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAUREN SIMICICH
Title or Position: OWNER
Credential: LCSW, LCADC
Phone: 609-807-8395