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General NPI Number Information
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NPI Number | 1699290080
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Entity Type | Individual
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Provider Name | LAUREN MATHEWS CADC
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Gender | Female
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 658 E BRIER DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2880
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Country | US
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Telephone | 909-252-5126
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Fax |
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Provider Business Mailing Address
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Address Line | 845 RANDOM LN
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City | DUARTE
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State | CA
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Zip | 91010-2041
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Country | US
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Telephone | 626-807-9789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CI28711219
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License Number State | CA
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