Provider Demographics
NPI:1922417294
Name:BYMA, LAUREN ELIZABETH (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:BYMA
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:BRINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:4845 CEDAR AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2034
Mailing Address - Country:US
Mailing Address - Phone:617-285-2673
Mailing Address - Fax:
Practice Address - Street 1:4845 CEDAR AVE
Practice Address - Street 2:APT. 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2034
Practice Address - Country:US
Practice Address - Phone:617-285-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09896101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor