Provider Demographics
NPI:1952183246
Name:MALLOY, LAUREN (LAC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MALLOY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 RECTOR ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4206
Mailing Address - Country:US
Mailing Address - Phone:908-421-5204
Mailing Address - Fax:
Practice Address - Street 1:320 SUYDAM ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2417
Practice Address - Country:US
Practice Address - Phone:732-246-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00751100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health