Healthcare Provider Details

I. General information

NPI: 1366277576
Provider Name (Legal Business Name): LAUREN AMANDA UCLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BRICK BLVD STE 204
BRICK NJ
08723-7984
US

IV. Provider business mailing address

74 BRICK BLVD STE 204
BRICK NJ
08723-7984
US

V. Phone/Fax

Practice location:
  • Phone: 732-832-3444
  • Fax: 732-532-0801
Mailing address:
  • Phone: 732-832-3444
  • Fax: 732-532-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15138600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: