Provider Demographics
NPI:1427865666
Name:DREISCH, LAUREN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:DREISCH
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 1:17725 SW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5815
Mailing Address - Country:US
Mailing Address - Phone:786-301-3699
Mailing Address - Fax:
Practice Address - Street 1:17725 SW 90TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5815
Practice Address - Country:US
Practice Address - Phone:786-301-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist