Provider Demographics
NPI:1366792251
Name:MATTHEWS, LAUREN MARIE (MA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 GARDNER DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7705
Mailing Address - Country:US
Mailing Address - Phone:440-376-0960
Mailing Address - Fax:
Practice Address - Street 1:12524 TRIPLE CROWN RD
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-3746
Practice Address - Country:US
Practice Address - Phone:440-376-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital