Provider Demographics
NPI:1609988724
Name:ROBERTS, LAUREN (MA)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1405 SE GOLDTREE DR STE C
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7563
Mailing Address - Country:US
Mailing Address - Phone:217-246-0766
Mailing Address - Fax:
Practice Address - Street 1:1405 SE GOLDTREE DR STE AD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7563
Practice Address - Country:US
Practice Address - Phone:217-246-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000972101YP2500X
FLMH18650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional