Provider Demographics
NPI:1326416173
Name:VERSHON, LAUREN (MFA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VERSHON
Suffix:
Gender:F
Credentials:MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1117
Mailing Address - Country:US
Mailing Address - Phone:908-268-1950
Mailing Address - Fax:
Practice Address - Street 1:670R MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-5003
Practice Address - Country:US
Practice Address - Phone:781-316-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C07700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical