Provider Demographics
NPI:1609360148
Name:WAITROVICH, LAUREN (MFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WAITROVICH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4036
Mailing Address - Country:US
Mailing Address - Phone:925-420-0968
Mailing Address - Fax:
Practice Address - Street 1:907 SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4036
Practice Address - Country:US
Practice Address - Phone:925-420-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94665106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist