Provider Demographics
NPI:1972814499
Name:KILLEEN, LAUREN A (PHD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:KILLEEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1518
Mailing Address - Street 2:
Mailing Address - City:EAST ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-0023
Mailing Address - Country:US
Mailing Address - Phone:781-325-8977
Mailing Address - Fax:339-707-7112
Practice Address - Street 1:927 MASSACHUSETTS AVE STE 3
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4627
Practice Address - Country:US
Practice Address - Phone:781-325-8977
Practice Address - Fax:339-707-7112
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9544103TC2200X
RIPS01314103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528432275OtherNPI