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General NPI Number Information
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NPI Number | 1386139269
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Entity Type | Organization
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Legal Business Name | LAUREN KRUG, PH.D., LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 255 S 17TH ST STE 1606
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6216
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Country | US
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Telephone | 215-648-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 4336 PINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LAUREN RAE KRUG
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Credential | PH.D.
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Telephone | 215-648-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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