Provider Demographics
NPI:1770029746
Name:TAVERAS, LAUREN C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:C
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 E WARNER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3354
Mailing Address - Country:US
Mailing Address - Phone:480-382-4416
Mailing Address - Fax:
Practice Address - Street 1:5010 E WARNER RD STE 108
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3354
Practice Address - Country:US
Practice Address - Phone:480-382-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005234103TC0700X
390200000X
AZ0005234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program