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General NPI Number Information
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NPI Number | 1962129056
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Entity Type | Individual
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Provider Name | LAUREN PETERS LISW-S
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Gender | Female
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Dates
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Enumeration Date | 10/20/2022
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 3333 BURNET AVE ML-6019
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City | CINCINNATI
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State | OH
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Zip | 45229-3026
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Country | US
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Telephone | 513-636-4124
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Fax | 513-636-4283
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Provider Business Mailing Address
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Address Line | 10227 CHERRY TREE TER
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City | DAYTON
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State | OH
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Zip | 45458-9431
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Country | US
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Telephone | 937-831-1104
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2203795
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.2203795-SUPV
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License Number State | OH
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