Provider Demographics
NPI:1215810197
Name:BROADWELL, LAUREN (LAC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BROADWELL
Suffix:
Gender:X
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1516
Mailing Address - Country:US
Mailing Address - Phone:908-217-1243
Mailing Address - Fax:
Practice Address - Street 1:60 UNION AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1516
Practice Address - Country:US
Practice Address - Phone:908-217-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00895100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health