Healthcare Provider Details

I. General information

NPI: 1891506861
Provider Name (Legal Business Name): LAUREN DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MADISON AVE
NEW YORK NY
10010-1600
US

IV. Provider business mailing address

699 SAN FERNANDO DR SE
SMYRNA GA
30080-1478
US

V. Phone/Fax

Practice location:
  • Phone: 855-629-0554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: