MEDICARE: LAUREN ZANIBONI PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY10000823	MA

General Provider Information

NPI Number	:	1164118188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ZANIBONI PSYD

Provider Business Mailing Address
First Line	:	52 RUTLAND SQ
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-3106
Country	:	US
Telephone Number	:	619-993-3876
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 FOREST ST
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02452-4713
Country	:	US
Telephone Number	:	619-993-3876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	06/13/2026

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