Provider Demographics
NPI:1790309409
Name:DIAZ, LAUREN AUBREY (MPS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:AUBREY
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MPS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:AUBREY
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:179 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179 LEONARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1802
Practice Address - Country:US
Practice Address - Phone:512-964-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist