Provider Demographics
NPI:1689967432
Name:GIAMMALVO, LAUREN ALINE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALINE
Last Name:GIAMMALVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:SAFIOLEAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 767938
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-7938
Mailing Address - Country:US
Mailing Address - Phone:818-241-6780
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:10 DORRANCE ST STE 700
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-2014
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:818-241-6853
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst