Provider Demographics
NPI:1811781156
Name:BERBERICH, LAUREN (MA, EDS, NCSP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BERBERICH
Suffix:
Gender:
Credentials:MA, EDS, NCSP
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BERBERICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:500 TRINITY LN N APT 5111
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1235
Mailing Address - Country:US
Mailing Address - Phone:631-993-1724
Mailing Address - Fax:
Practice Address - Street 1:1802 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3406
Practice Address - Country:US
Practice Address - Phone:813-444-8760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1944103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool