Provider Demographics
NPI:1962171348
Name:WONG, LAUREN (EDM)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 HUNTINGTON AVE
Mailing Address - Street 2:1703-88774
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3134
Mailing Address - Country:US
Mailing Address - Phone:781-443-8344
Mailing Address - Fax:844-364-6593
Practice Address - Street 1:177 HUNTINGTON AVE
Practice Address - Street 2:1703-88774
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3134
Practice Address - Country:US
Practice Address - Phone:781-443-8344
Practice Address - Fax:844-364-6593
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health