Provider Demographics
NPI:1730322694
Name:SCHWARZ, LAUREN RALLO (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RALLO
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:RALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1438 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1027
Mailing Address - Country:US
Mailing Address - Phone:314-977-4800
Mailing Address - Fax:
Practice Address - Street 1:1438 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1027
Practice Address - Country:US
Practice Address - Phone:314-977-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028913103T00000X, 103TC0700X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical