Provider Demographics
NPI:1952702425
Name:SHIBLEY, LAUREN BETH
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:BETH
Last Name:SHIBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 PONTIAC AVE APT 14101
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5941
Mailing Address - Country:US
Mailing Address - Phone:401-632-6801
Mailing Address - Fax:
Practice Address - Street 1:825 PONTIAC AVENUE APT 14101
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910
Practice Address - Country:US
Practice Address - Phone:401-632-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health