Provider Demographics
NPI:1881980845
Name:GROVER, LAUREN E (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:E
Last Name:GROVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:57 BEDFORD ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4500
Mailing Address - Country:US
Mailing Address - Phone:774-364-1168
Mailing Address - Fax:781-861-2057
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 125
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:774-364-1168
Practice Address - Fax:781-861-2057
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216080101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MA1303287OtherMBHP
MA0000023532OtherBMC
MA1303287Medicaid
MAM18633OtherBCBS
MA042611055OtherTAX ID
MA99618201OtherNETWORK HEALTH