Provider Demographics
NPI:1982852133
Name:LOVELL, LAUREN A (MED)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:A
Last Name:LOVELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 SW 34TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5147
Mailing Address - Country:US
Mailing Address - Phone:239-850-3679
Mailing Address - Fax:239-205-8889
Practice Address - Street 1:6150 DIAMOND CENTRE CT BLDG 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4367
Practice Address - Country:US
Practice Address - Phone:239-850-3679
Practice Address - Fax:239-205-8889
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2321103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst