Provider Demographics
NPI:1174776090
Name:RICHARDS, LAUREN JENNIFER
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JENNIFER
Last Name:RICHARDS
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 1:45 KIDDER AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2005
Mailing Address - Country:US
Mailing Address - Phone:850-294-8900
Mailing Address - Fax:
Practice Address - Street 1:366 SOMERVILLE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2919
Practice Address - Country:US
Practice Address - Phone:617-628-8815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health