Healthcare Provider Details

I. General information

NPI: 1063781391
Provider Name (Legal Business Name): LAUREN V STENZEL LCSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SW THE PINES DR
DEPOE BAY OR
97341-9598
US

IV. Provider business mailing address

206 SW THE PINES DR
DEPOE BAY OR
97341-9598
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-1733
  • Fax:
Mailing address:
  • Phone: 505-288-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL005250
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: