Provider Demographics
NPI:1689933574
Name:PARKE, LAUREN MICHELLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:PARKE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-1906
Mailing Address - Country:US
Mailing Address - Phone:732-235-5910
Mailing Address - Fax:609-514-0420
Practice Address - Street 1:4326 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-1906
Practice Address - Country:US
Practice Address - Phone:732-235-5910
Practice Address - Fax:609-514-0420
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701OtherAGENCY MEDICAID PROVIDER #
NJ8363102OtherAGENCY PROGRAM MEDICAID PROVIDER #