Provider Demographics
NPI:1821618901
Name:LAUREN DRAKE, LLC
Entity Type:Organization
Organization Name:LAUREN DRAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-239-5744
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:419-239-5744
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty