Provider Demographics
NPI:1912451576
Name:LAUREN KLOOS, LLC
Entity Type:Organization
Organization Name:LAUREN KLOOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOOS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-203-1692
Mailing Address - Street 1:382 POND ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-2892
Mailing Address - Country:US
Mailing Address - Phone:508-203-1695
Mailing Address - Fax:508-459-8709
Practice Address - Street 1:31 HAYWARD ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2166
Practice Address - Country:US
Practice Address - Phone:508-203-1692
Practice Address - Fax:508-459-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1165561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1366691156Medicaid