Provider Demographics
NPI:1659710028
Name:DRAKE, LAUREN T (LISW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:T
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2116
Mailing Address - Country:US
Mailing Address - Phone:440-239-5744
Mailing Address - Fax:
Practice Address - Street 1:400 TENNEY AVE STE 114
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2268
Practice Address - Country:US
Practice Address - Phone:567-623-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI16002761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid