Provider Demographics
NPI:1669579546
Name:GOLDSTEIN, LAUREN (LICENSED CLINICAL SO)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MONROE TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468
Mailing Address - Country:US
Mailing Address - Phone:203-362-9514
Mailing Address - Fax:203-220-2325
Practice Address - Street 1:227 MONROE TURNPIKE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468
Practice Address - Country:US
Practice Address - Phone:203-362-9514
Practice Address - Fax:203-220-2325
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002831104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker