Provider Demographics
NPI:1609092212
Name:LIBERTY, LAUREN RAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:RAE
Last Name:LIBERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:RAE
Other - Last Name:HONEYCHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2121
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-2121
Mailing Address - Country:US
Mailing Address - Phone:209-304-3986
Mailing Address - Fax:
Practice Address - Street 1:10400 FRICOT CITY RD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9642
Practice Address - Country:US
Practice Address - Phone:209-304-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 228031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical