Provider Demographics
NPI:1700447505
Name:SMITH, LAUREN D
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 NW 174TH TER APT 403
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7121
Mailing Address - Country:US
Mailing Address - Phone:954-825-3371
Mailing Address - Fax:
Practice Address - Street 1:5881 NW 151ST ST STE 111
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2455
Practice Address - Country:US
Practice Address - Phone:954-825-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician