Provider Demographics
NPI:1275247595
Name:GINGRICH, LAUREN (LSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 SAMOSA HILL CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-4935
Mailing Address - Country:US
Mailing Address - Phone:937-408-6090
Mailing Address - Fax:
Practice Address - Street 1:3024 SAMOSA HILL CIR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-4935
Practice Address - Country:US
Practice Address - Phone:937-408-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134009104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA