Provider Demographics
NPI:1801062435
Name:DEAVEN, LAUREN (ATR-BC, CLAT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:DEAVEN
Suffix:
Gender:F
Credentials:ATR-BC, CLAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 RANDOM RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1451
Mailing Address - Country:US
Mailing Address - Phone:917-209-9769
Mailing Address - Fax:
Practice Address - Street 1:129 RANDOM RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1451
Practice Address - Country:US
Practice Address - Phone:917-209-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000074221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist