MEDICARE: LAUREN A CONNOR M.ED.

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	101YS0200X	School Counselor	819023	NJ

General Provider Information

NPI Number	:	1649555764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN A CONNOR M.ED.

Provider Business Mailing Address
First Line	:	1222 PANAMA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5920
Country	:	US
Telephone Number	:	856-373-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1222 PANAMA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5920
Country	:	US
Telephone Number	:	856-373-0211
Fax Number	:

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

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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