Provider Demographics
NPI:1487026639
Name:FREDERICK, LAUREN (BCBS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:BCBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3220
Mailing Address - Country:US
Mailing Address - Phone:800-774-5516
Mailing Address - Fax:856-429-4755
Practice Address - Street 1:425 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1206
Practice Address - Country:US
Practice Address - Phone:800-774-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst