Provider Demographics
NPI:1285993261
Name:SISSELBERGER, LAUREN (MED)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SISSELBERGER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:SISSELBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:4479 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5403
Mailing Address - Country:US
Mailing Address - Phone:302-897-1369
Mailing Address - Fax:772-489-0423
Practice Address - Street 1:2222 COLONIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-5309
Practice Address - Country:US
Practice Address - Phone:772-489-4726
Practice Address - Fax:772-489-0423
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health