Provider Demographics
NPI:1437642527
Name:OTTENHOFF, LAUREN BEAM (MA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BEAM
Last Name:OTTENHOFF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PARK ST NE STE 3B
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4666
Mailing Address - Country:US
Mailing Address - Phone:302-259-1736
Mailing Address - Fax:
Practice Address - Street 1:133 PARK ST NE STE 3B
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4666
Practice Address - Country:US
Practice Address - Phone:703-622-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling