Provider Demographics
NPI:1306323662
Name:DE MENEZES, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DE MENEZES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 APOSTLE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4655
Mailing Address - Country:US
Mailing Address - Phone:951-850-2484
Mailing Address - Fax:
Practice Address - Street 1:1868 APOSTLE LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4655
Practice Address - Country:US
Practice Address - Phone:951-850-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist