Provider Demographics
NPI:1366004251
Name:HOLLEB, LAUREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:HOLLEB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:HOLLEB
Other - Last Name:SURRETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:92 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3822
Mailing Address - Country:US
Mailing Address - Phone:317-946-5686
Mailing Address - Fax:
Practice Address - Street 1:1 COLLEGE CIR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2999
Practice Address - Country:US
Practice Address - Phone:207-992-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1397103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent