Provider Demographics
NPI:1639852221
Name:MALO, LAUREN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MALO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:GOLDBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1250 EXECUTIVE PL STE 501
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2482
Mailing Address - Country:US
Mailing Address - Phone:630-345-6755
Mailing Address - Fax:
Practice Address - Street 1:1250 EXECUTIVE PL STE 501
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2482
Practice Address - Country:US
Practice Address - Phone:630-345-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0257881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical