Provider Demographics
NPI:1093968331
Name:WREN, LAURIE L (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:L
Last Name:WREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PRIMERA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2125
Mailing Address - Country:US
Mailing Address - Phone:407-333-0404
Mailing Address - Fax:407-833-3771
Practice Address - Street 1:725 PRIMERA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2125
Practice Address - Country:US
Practice Address - Phone:407-333-0404
Practice Address - Fax:407-833-3771
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical