MEDICARE: LAUREN M PEAKE

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	27834	CA

General Provider Information

NPI Number	:	1588099873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN M PEAKE

Provider Business Mailing Address
First Line	:	250 W SEASIDE WAY
Second Line	:	APT 3305
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7904
Country	:	US
Telephone Number	:	609-828-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W SEASIDE WAY
Second Line	:	APT 3305
City	:	LONG BEACH
State	:	CA
Zip	:	90802-7904
Country	:	US
Telephone Number	:	609-828-0160
Fax Number	:

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

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	02/04/2016

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Directions to “ LAUREN M PEAKE ” Practice Location

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