Provider Demographics
NPI:1568013399
Name:BALL, LAUREN RANDALL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RANDALL
Last Name:BALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40626 DUTTON ST
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92223-4534
Mailing Address - Country:US
Mailing Address - Phone:909-747-4163
Mailing Address - Fax:
Practice Address - Street 1:40626 DUTTON ST
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92223-4534
Practice Address - Country:US
Practice Address - Phone:909-747-4163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW195601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical