=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689047912
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN LIVORSI LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2015
-----------------------------------------------------
Last Update Date | 08/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 MAIN ST SUITE 1
-----------------------------------------------------
City | HIGHTSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08520-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-616-1707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 102 MAIN ST SUITE 1
-----------------------------------------------------
City | HIGHTSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08520-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-616-1707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05595800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------