Provider Demographics
NPI:1285406397
Name:PATRICK-MUDD, LAUREN BETH (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BETH
Last Name:PATRICK-MUDD
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 1:135 E OLIVE AVE # 4174
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1820
Mailing Address - Country:US
Mailing Address - Phone:818-391-9540
Mailing Address - Fax:
Practice Address - Street 1:517 E CYPRESS AVE APT D
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3239
Practice Address - Country:US
Practice Address - Phone:818-391-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1185361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical