Provider Demographics
NPI:1720454002
Name:POLEYEFF, LAUREN (PSYD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:POLEYEFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ROSEMONT TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2216
Mailing Address - Country:US
Mailing Address - Phone:973-243-0888
Mailing Address - Fax:
Practice Address - Street 1:41 ROSEMONT TER
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2216
Practice Address - Country:US
Practice Address - Phone:973-243-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ153-038103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist