Provider Demographics
NPI:1821579541
Name:AZEVEDO, LAUREN (LICSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02346
Mailing Address - Country:US
Mailing Address - Phone:085-923-5369
Mailing Address - Fax:
Practice Address - Street 1:52 OAK STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02346-1984
Practice Address - Country:US
Practice Address - Phone:508-923-5369
Practice Address - Fax:508-923-5344
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1269021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty