Provider Demographics
NPI:1770874166
Name:PEDERSEN, LAUREN MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MAIN ST
Mailing Address - Street 2:SUITE 411
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2296
Mailing Address - Country:US
Mailing Address - Phone:860-826-2269
Mailing Address - Fax:860-826-2213
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:SUITE 411
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2296
Practice Address - Country:US
Practice Address - Phone:860-826-2269
Practice Address - Fax:860-826-2213
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1449106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist