Provider Demographics
NPI:1104307925
Name:GAVRON, LAUREN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:GAVRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S OSPREY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5819
Mailing Address - Country:US
Mailing Address - Phone:941-216-7272
Mailing Address - Fax:941-253-3530
Practice Address - Street 1:107 S OSPREY AVE STE 100
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5819
Practice Address - Country:US
Practice Address - Phone:941-216-7272
Practice Address - Fax:941-253-3530
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FLPY10232103TC0700X
FL10232103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical