Healthcare Provider Details

I. General information

NPI: 1710349709
Provider Name (Legal Business Name): LAUREN CONWAY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S GREENWOOD AVE
EASTON PA
18045-9800
US

IV. Provider business mailing address

650 S GREENWOOD AVE
EASTON PA
18045-9800
US

V. Phone/Fax

Practice location:
  • Phone: 484-212-5189
  • Fax:
Mailing address:
  • Phone: 484-212-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004472
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: