Provider Demographics
NPI:1083460752
Name:LAHANE, MAYURI
Entity type:Individual
Prefix:
First Name:MAYURI
Middle Name:
Last Name:LAHANE
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 1:28901 NE 156TH ST
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8018
Mailing Address - Country:US
Mailing Address - Phone:213-361-1175
Mailing Address - Fax:
Practice Address - Street 1:14524 MAIN ST NE STE 111
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8467
Practice Address - Country:US
Practice Address - Phone:425-505-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician