=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407616055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN CANTOR MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2024
-----------------------------------------------------
Last Update Date | 03/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 759 SW FEDERAL HWY STE 203
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-281-0599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5163 N HIGHWAY A1A APT 417
-----------------------------------------------------
City | HUTCHINSON ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34949-8218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-806-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | IMH25581
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------