Healthcare Provider Details

I. General information

NPI: 1710702915
Provider Name (Legal Business Name): LAUREN GOODWIN M.ED, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PHEASANT RUN STE 100
NEWTOWN PA
18940-1877
US

IV. Provider business mailing address

2924 HAMILTON CT
BENSALEM PA
19020-1824
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-0670
  • Fax:
Mailing address:
  • Phone: 215-688-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH007059
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: