MEDICARE: LAUREN NOELLE MAGRETA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1669931580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN NOELLE MAGRETA

Provider Business Mailing Address
First Line	:	973 HIGH RIDGE DR
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-5010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30685 BARRINGTON ST
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-5111
Country	:	US
Telephone Number	:	248-965-3916
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	04/23/2024

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Directions to “ LAUREN NOELLE MAGRETA ” Practice Location

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