Provider Demographics
NPI:1952821977
Name:HANEMAN, LAUREN PALMIERI (MSED, LBS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PALMIERI
Last Name:HANEMAN
Suffix:
Gender:F
Credentials:MSED, LBS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:PALMIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED LBS
Mailing Address - Street 1:606 E BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1751
Mailing Address - Country:US
Mailing Address - Phone:484-443-8890
Mailing Address - Fax:
Practice Address - Street 1:3744 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3224
Practice Address - Country:US
Practice Address - Phone:610-864-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6006824907746020317Medicaid