Provider Demographics
NPI:1497048912
Name:KACZKA-WEISS, LAUREN (DO)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:KACZKA-WEISS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 ROUTE 88
Mailing Address - Street 2:FL 3
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3018
Mailing Address - Country:US
Mailing Address - Phone:504-988-7829
Mailing Address - Fax:504-988-4264
Practice Address - Street 1:1440 CANAL ST # TB52
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2703
Practice Address - Country:US
Practice Address - Phone:504-988-7829
Practice Address - Fax:504-988-4264
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LADO.0003202084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty