Provider Demographics
NPI:1427446970
Name:FREER, LAUREN MARIE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:FREER
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 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4848
Mailing Address - Country:US
Mailing Address - Phone:203-371-7048
Mailing Address - Fax:203-371-7066
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4848
Practice Address - Country:US
Practice Address - Phone:203-371-7048
Practice Address - Fax:203-371-7066
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3255363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1427446970Medicaid