Provider Demographics
NPI:1962444927
Name:CARTER, LAUREN (LISW)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:7575 FREDLE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9413
Mailing Address - Country:US
Mailing Address - Phone:440-725-6101
Mailing Address - Fax:440-350-6212
Practice Address - Street 1:7575 FREDLE DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CONCORD
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-725-6101
Practice Address - Fax:440-350-6212
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00072511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCARESOURCE 450486565Medicaid
OH45-0486565OtherIRS TAX IDENTIFICATION NUMBER
OH2736267Medicaid