Provider Demographics
NPI:1497646376
Name:VINCENT, LAUREN NICOLE
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:NICOLE
Last Name:VINCENT
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 1:15069 BAY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6326
Mailing Address - Country:US
Mailing Address - Phone:951-750-9367
Mailing Address - Fax:
Practice Address - Street 1:3880 LEMON ST STE 500
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3374
Practice Address - Country:US
Practice Address - Phone:951-530-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94028998103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist