Provider Demographics
NPI:1609085877
Name:MIRKIN, LAUREN ILENE (MS, CNS, LDN LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ILENE
Last Name:MIRKIN
Suffix:
Gender:F
Credentials:MS, CNS, LDN LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2520 WILLOW GLEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:443-326-7023
Mailing Address - Fax:
Practice Address - Street 1:2360 WEST JOPPA RD. JOPPA CONCOURSE, SUITE 200
Practice Address - Street 2:JOHNS HOPKINS INTEGRATIVE MEDICINE AND DIGESTIVE CENTER
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-828-3585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2974133N00000X
MDLC5610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional