Provider Demographics
NPI:1609914035
Name:SUVAK, LAUREN S (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:S
Last Name:SUVAK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:EASTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:13 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1315
Mailing Address - Country:US
Mailing Address - Phone:617-513-3725
Mailing Address - Fax:
Practice Address - Street 1:425 HIGH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3674
Practice Address - Country:US
Practice Address - Phone:781-395-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10301441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22652Medicare ID - Type Unspecified
MAP07939Medicare UPIN
MA1029170Medicare UPIN