Provider Demographics
NPI:1104240142
Name:STOCKLY, LAUREN (LCSW, RPT-S, ECMHS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:STOCKLY
Suffix:
Gender:F
Credentials:LCSW, RPT-S, ECMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 HOPE ST STE 350
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2658
Mailing Address - Country:US
Mailing Address - Phone:626-737-1732
Mailing Address - Fax:
Practice Address - Street 1:1605 HOPE ST STE 350
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2658
Practice Address - Country:US
Practice Address - Phone:626-737-1732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA717071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-1946482Medicaid