Provider Demographics
NPI:1013542612
Name:GOROG, LAUREN SYLVIA (PSYD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SYLVIA
Last Name:GOROG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3434
Mailing Address - Country:US
Mailing Address - Phone:720-295-5621
Mailing Address - Fax:
Practice Address - Street 1:3570 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3434
Practice Address - Country:US
Practice Address - Phone:720-295-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004943103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical