Provider Demographics
NPI:1114405453
Name:KALOGRIDIS, LAUREN (LCSW, PMH-C, CD-DTI)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KALOGRIDIS
Suffix:
Gender:F
Credentials:LCSW, PMH-C, CD-DTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 HOLCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2427
Mailing Address - Country:US
Mailing Address - Phone:530-414-9952
Mailing Address - Fax:
Practice Address - Street 1:1030 HOLCOMB AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2427
Practice Address - Country:US
Practice Address - Phone:530-414-9952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
NV10295-C1041C0700X
NV0295-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula