Provider Demographics
NPI:1902192537
Name:LAMOUR BY DESIGN
Entity Type:Organization
Organization Name:LAMOUR BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:GUAN
Authorized Official - Middle Name:QUATEZ'
Authorized Official - Last Name:ELLERBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-444-4916
Mailing Address - Street 1:1215 WARREN AVE
Mailing Address - Street 2:#2REAR
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-6856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-6700
Practice Address - Country:US
Practice Address - Phone:774-444-4916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty