Provider Demographics
NPI:1326617010
Name:MILLER-FORD, LAUREN L
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:L
Last Name:MILLER-FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 W ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-1016
Mailing Address - Country:US
Mailing Address - Phone:267-847-7956
Mailing Address - Fax:
Practice Address - Street 1:3214 W ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19132-1016
Practice Address - Country:US
Practice Address - Phone:267-847-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YS0200X
PAPC008447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool