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General NPI Number Information
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NPI Number | 1699322313
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Entity Type | Individual
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Provider Name | KRISTEN LOURENS LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/19/2019
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 64B REGENT ST
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City | ROXBURY
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State | MA
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Zip | 02119-1980
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Country | US
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Telephone | 617-861-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 83 WITHINGTON RD
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City | NEWTON
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State | MA
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Zip | 02460-2037
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Country | US
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Telephone | 860-899-0969
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11400
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License Number State | MA
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