Provider Demographics
NPI:1043729387
Name:PARK, LAUREN (LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 ANDOVER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1521
Mailing Address - Country:US
Mailing Address - Phone:617-431-8394
Mailing Address - Fax:
Practice Address - Street 1:243 ANDOVER ST FL 2
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1521
Practice Address - Country:US
Practice Address - Phone:617-431-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2195431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical