Provider Demographics
NPI:1407616055
Name:CANTOR, LAUREN (MS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CANTOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5163 N HIGHWAY A1A APT 417
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34949-8218
Mailing Address - Country:US
Mailing Address - Phone:330-806-4200
Mailing Address - Fax:
Practice Address - Street 1:759 SW FEDERAL HWY STE 203
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2972
Practice Address - Country:US
Practice Address - Phone:772-281-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty